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ThefollowingisageneralizedoutlineforrehabilitationfollowingACLreconstruction.Theprotocolmaybemodifiedif
additionalprocedures,suchasmeniscusrepairormicrofracture,wereperformed.
PhaseI:114days
Goals
Protectgraftandgraftfixationwithuseofbraceandspecificexercises
Controlinflammationandswelling
Earlyrangeofmotion(ROM)withemphasisonfullextension,patellamobilizationsandflexion
Caution:avoidhyperextensiongreaterthan10
Educatepatientonrehabilitationprogression
Restorenormalgaitonlevelsurfaces
Brace
Postopbracewornlockedinextensionforambulationandsleeping
MayunlockforROMexercises
Weightbearingstatus
Weightbearingastoleratedwithcrutchesandbracelockedinextension
Ifmeniscalrepairormicrofracture,nonweightbearingfor4weeks
Exercises
ContinuousPassiveMotion(CPM)machine2hoursessions,3timesadayatslow,comfortablespeed.Startat
50offlexion,andincrease10perdayupto90
ROMexercises(seefiguresbelow)
Extensionnoactiveterminalextensionfrom40to0
Passiveextensionsitinachairandplaceyourheelontheedgeofastoolorchair;relaxthigh
musclesandletthekneesagunderit'sownweightuntilmaximumextensionisachieved.
Heelpropsplacerolleduptowelundertheheelandallowlegtorelax
Pronehangsliefacedownonatable/bedwiththelegshangingofftheedgeofthetable;allow
thelegstosagintofullextension.
Flexionlimitto90
Passiveflexionsitonchair/edgeofbedandletkneebendundergravity;mayusetheotherleg
tosupportandcontrolflexion
WallslidesLieonyourbackwiththeinvolvedfootonthewallandallowthefoottoslidedown
thewallbybendingtheknee;useotherlegtoapplypressuredownward.
HeelslidesUseyourgoodlegtopulltheinvolvedheeltowardthebuttocks,flexingtheknee.
Holdfor5seconds;straightenthelegbyslidingtheheeldownwardandholdfor5seconds.
Quadricepssetsinfullextension
Straightlegraisesinbracelockedinextension
Hamstringsets
Patellamobilization
Isometrichipabduction,adduction
AnkleROMandgastocsoleusstrengtheningwithtubing/therabands
PhaseII:Weeks36
Goals
Mayweanoutofpostbracewhendemonstrategoodquadcontrol
Weightbearingstatus
Weightbearingastolerated,weanoffcrutches
Exercises
Continueasabove,maintainingfullextensionandprogressingto125
Noactiveterminalextensionfrom40to0
Beginclosedkineticchainexercises
Stationarybicycling,stairmaster:slow,progressingtolowresistance
Hamstringcurls
Hipabduction,adduction,extension
At46weeks,partialsquats,usetableforsupport
PhaseIII:Weeks612
Goals
Fullactiverangeofmotion
Increasestrength
Exercises
Stationarybicycling,stairmaster,elliptical:increasesresistance
Treadmillwalking
Swimming,waterconditioning:flutterkickonly
Balanceandproprioceptivetraining
Closedchainquadstrengthening:nokneeflexiongreaterthan90withlegpress
PhaseIV:Months36
Goals
Improvestrength,enduranceandproprioception
Beginagilitytraining
Brace
FunctionalACLbrace
Exercises
Maystartjoggingprogram,forward/straightrunningonly
Continueandprogressstrengthening
Progresstorunningprogramat5months
Beginagilitytrainingat5months
o Side steps
o Crossovers
o Figure 8 running
o Shuttle running
o One leg and two leg jumping
o Cutting
o Acceleration/deceleration/sprints
o Agility ladder drills
Initiatesportspecificdrillsasappropriate
PhaseV:6monthspostop
Goals
Maintainstrength,enduranceandproprioception
Safereturntosport
Brace
FunctionalACLbraceforcontactsports,jumpingandlandingorcuttingandtwistinguntil1yearpostop,then
perpatientpreference
Exercises
Gradualreturntosportsparticipation
Maintenanceprogramforstrength,endurance
Returntosportscriteria
MDclearance
Fullrangeofmotion
Noswelling
Goodstabilityonligamenttesting
Fullstrengthcomparedtootherleg
Completedsportspecificfunctionalprogression
Runningandjumpingwithoutpainorlimp
EXERC
CISEFIGUR
RES
Heelprops
Pronehangs
Passiiveflexion
Wallslides
Heelslides
Straightlegraisess Partialsquats