ACL Reconstruction Rehabilitation Protocol
ACL reconstruction surgery takes between 1 hour to 1 1/2 hours to perform.
The next 6 months is very important if the athlete wants to get back to high level sports.
A proper rehabilitation protocol is needed to allow the graft to heal, mature and strengthen while the knee becomes stronger.
The importance of post-ACL reconstruction rehabilitation cannot be over emphasized.
ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
REHABILITATION PROTOCOL
Stage 2 – Week 1 to 2 immediate post-surgery
Stage 3 – Week 2 to 6 Hamstring and Quadriceps Control
Stage 4 – Week 6 to 12 Proprioception
Stage 5 – 3 to 6 months Sports-specific activities
Stage 6 – 6 to 9 months Return to Sports
Stage 1 – Pre-surgery
| Goals | Physiotherapy |
| Reduce pain and swelling | Cryotherapy |
| Achieve full ROM | Heel slides |
| Improve quads strength | Isometric quads |
| Goals | Physiotherapy |
| Reduce swelling & Pain | ICE, Cryotherapy |
| Restore ROM: 0 – 90 | Heel slides, active/passive knee flexion, prone hangs, Achieve full knee extension |
| Restore patella mobility | Patella mobilisation |
| Hamstrings and quadriceps muscle control to 4/5 | Isometric quads, electical stim on VMO, SLR, hamstring stretches |
Watch out for: infection, stiffness, over-stretch graft, bleeding, DVT
Stage 3 – Week 2 to 6 Hamstring & Quadriceps Control
| Goals | Physiotherapy |
| Continue to reduce swelling and inflammation | Cryotherapy |
| Increase ROM 0 to 130 | Heel slides, active/passive ROM, prone hangs, heel prop |
| Normal gait pattern in FWB | Gait training, pool exercises |
| Increase hamstring and quads control | Quads/hamstrings co-contractions, Hamstring curls, Leg presses, hip strengthening, Step ups/downs, stationary cyclingMini lunges
Wall squats up to 70 degrees knee flexion |
| Commence proprioceptive work | Static balance exercises, progress to wobble board or balance pad, trampoline |
| Goals | Physiotherapy |
| Full ROM | Able to sit on heels pain free |
| Quads strength 85% of non-injured knee | Progressive strengthening exercises in gym and pool, Begin endurance training |
| Improved neuromuscular control and proprioception | Start treadmill walking – flat and slowly increase to 12 degrees incline, Progress to jogging in straight line, Swiss ball exercises, Swimming – light kick, no breast stroke, Dynamic balance exercises with balance pad, wobble board |
| Increase hamstring strength | Increase weight and repetitions of hamstring curls, Cycling on road |
| Goals | Physiotherapy |
| Preparation for return to sport. Improve skill level. | Functional sport-specific exercises in controlled situation (no pivoting) |
| Improve agility and reaction time drills | More advanced agility drills (Figure of 8s, start-stops, change directions forwards and backwards, low speed cutting), Plyometrics – hopping, jumping, skipping |
| Increase total leg strength and fitness | Progress to strength and conditioning programme |
| Develop patient confidence | Isokinetic test |
| Goals | Physiotherapy |
| Return to full agility. Functional test 80% of non-operative leg. Prioprioception 100% of non-operative leg | Increase speed with figure of 8s, sprint stop-start, change surfaces, jumping bilaterally and unilaterally with increase height and surface |
| Return to Sport | Sport specific training – drills with equipment on sport-specific surface, Unrestricted training, match play |
