ACL Rehabilitation

ACL Rehabilitation

1. Post-operative phase I (weeks 0–2)

   • Goals
     • Emphasis on full passive extension
     • Control pain
     • Early progressive weight bearing
     • Prevent quadriceps inhibition
   • Strategies
     • Towel extensions, prone hangs.
       • Patella mobilization
         • Active flexion/active-assisted extension
     • Progressive weight bearing
       • Hip progressive resisted exercises
         • Leg press
       • Upper extremity cardiovascular exercises as tolerated
         • Cryotherapy

2. Post-operative phase 2 (weeks 2–6)

   • Goals
     • ROM 0° → 130°
       • Ascend 8″ stairs with good control without pain
     • Patella mobility
   • Strategies
     • Progressive weight bearing
       • Mini squats/weight shifts
         • Stairmaster
           • Progressive resistance
             • Hamstring/calf flexibility exercises
             • Core stabilization exercises
               • Active knee extension
     • Leg press (90° → 0° arc)
       • Proprioception training: prop board/balance system/contralateral Theraband exercises
         • Hip strengthening all directions (with ankle weight). Both concentric & eccentric exercises.

3. Post-operative phase 3 (weeks 6–14)

   • Goals
     • Restore Full ROM
     • Descend 8 stairs with good leg control without pain
       • Improve endurance
       • Improve lower extremity flexibility
         • Protect patellofemoral joint
   • Strategies
     • Progress squat program
       • Isometric → isotonic knee extensions 90° → 40°
         • Quadriceps stretching
       • Agility exercises
         • Retrograde treadmill ambulation/running
           • Eccentric lateral step downs (slow, controlled knee flexion)
             • Exercise bike (increasing time & resistance)
               • Swimming (flutter kick only)
           • Full wall squats (up to 90°).
     • Leg press
       • Lunges

4. Post-operative phase 4 (weeks 14–22)

   • Strategies
     • Start forward running (treadmill) program
       • Continue strengthening and flexibility programs
         • Isotonic knee extension (full arc/pain and crepitus free)
         • Isokinetic training (fast → moderate velocities)
           • Eccentric step downs (20cm)
             • Low resistance jumping (2 legs, then jogging, then single leg hops)
       • Advance agility program/sport specific
         • Start plyometric program
   • Goals
     • Ability to run pain free
       • Isokinetic test ≥85% limb symmetry
     • Maximize strength and flexibility as to meet demands of activities of daily living

5. Post-operative phase 5—return to sport (weeks 22–?)

   • Strategies
     • Strengthening, flexibility, and agility programs
     • Advance plyometric program
       • Brace for sport activity
         • Isokinetic test, hop test(s), quality movement assessment at 6 months
   • Goals
     • Lack of apprehension with sport specific movements
       • Acceptable quality movement assessment
         • BIBLIOGRAPHY:
           • John T. Cavanaughcorresponding author and Matthew Powers. (2017). ACL Rehabilitation Progression. 2017 Aug 8, de US National Library of Medicine National Institutes of Health Search database Sitio web: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577427/
             • URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577427/
     • Maximize strength and flexibility as to meet demands of individual’s sport activity
       • Isokinetic test ≥90% limb symmetry

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