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 1 – Pre-surgery physiotherapy

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

GoalsPhysiotherapy
Reduce pain and swellingCryotherapy
Achieve full ROMHeel slides
Improve quads strengthIsometric quads

Stage 2 – Week 1 to 2

GoalsPhysiotherapy
Reduce swelling & PainICE, Cryotherapy
Restore ROM: 0 – 90Heel slides, active/passive knee flexion, prone hangs, Achieve full knee extension
Restore patella mobilityPatella mobilisation
Hamstrings and quadriceps muscle control to 4/5Isometric 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

GoalsPhysiotherapy
Continue to reduce swelling and inflammationCryotherapy
Increase ROM 0 to 130Heel slides, active/passive ROM, prone hangs, heel prop
Normal gait pattern in FWBGait training, pool exercises
Increase hamstring and quads controlQuads/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 workStatic balance exercises, progress to wobble board or balance pad, trampoline

Stage 4 – Week 6 to 12 Proprioception

GoalsPhysiotherapy
Full ROMAble to sit on heels pain free
Quads strength 85% of non-injured kneeProgressive strengthening exercises in gym and pool, Begin endurance training
Improved neuromuscular control and proprioceptionStart 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 strengthIncrease weight and repetitions of hamstring curls, Cycling on road

Stage 5 – 3 to 6 months, Sports-specific activities

GoalsPhysiotherapy
Preparation for return to sport. Improve skill level.Functional sport-specific exercises in controlled situation (no pivoting)
Improve agility and reaction time drillsMore 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 fitnessProgress to strength and conditioning programme
Develop patient confidenceIsokinetic test

Stage 6 – 6 to 9 months, Return to sports

GoalsPhysiotherapy
Return to full agility. Functional test 80% of non-operative leg. Prioprioception 100% of non-operative legIncrease speed with figure of 8s, sprint stop-start, change surfaces, jumping bilaterally and unilaterally with increase height and surface
Return to SportSport specific training – drills with equipment on sport-specific surface, Unrestricted training, match play
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