Anterior Crucial Ligament (ACL) Reconstruction Rehabiliatation Guidelines

(Since i did not find a good physical therapy schedule on the web, i'm typing out what my PT gave me)

These notes are from Health South Doctors Hospital, Alex Lau

Post-Operative Week 1:

• VMO quad sets with biofeedback
• Straight leg raises
• Gentle patellar mobilization/scar mobilization
• Theraband ankle exercises
• EMS especially important if patient unable to initiate quad sets of independent SLR
• Prone extension
• Gastroc/hamstring streching
• Cryotherapy
• Manual/self ROM zero to 90 degrees

Post-Operative Week 2:

• Continue previous treatment
• Isotonic program (hip abduction/adduction, leg curl)
• Mini squats 0 - 30 degrees
  
• Wall slides 0 - 30 degrees
• Posterior tibial glide joint mobilization at 30 degrees and 90 degrees if ROM problem persists especially in ext
• Bicycle ROM 1/2 arcs progressing to full ROM

Post-Operative Week 3:

• KT-1000
• Continue with previous treatment
• Heel walking, toe walking
• Balance/proprioception training on flat terrain
• Reformer single leg press
• PROM/self ROM zero to 120 degrees sitting. Upon obtaining 110 degrees of flexion proceed with prone ROM
• O/C brace and crutches if ambulating without a limp

Post-Operative Week 4-6:

• Continue Isotonic program (hips, hamstrings, leg press)
• Continue with previous program
• Treadmill forward and backward walking
• Step ups
• Trampoline - single leg standing
• Balance board (lateral tilt, A/P tilt)
• Weight shifting (modified lunge to 30 degree flexion: forward, backward, sideways)
• Continue biofeedback for neuromuscular VMO re-education
  
• Aggressive patellar and soft tissue mob, post-tibial glides
• PROM/self ROM zero to 135 degrees seated, prone zero to 120 degrees
• Interval stationary bike program

At the end of 6 weeks, patient should have between zero to 135 degrees ROM, good patellar mobilization. Normal WB and gait. Minimal pain and swelling. Biofeedback can be included in closed chain activities


Post-Operative Weeks 6-12:

• Continue with previous treatment
• Isokinetics limited range (90-45 degrees), high speed above 150 to 180 degrees/sec at 10 weeks (If painfree and no patella femoral problems)
• Isotonic squats - Smith Machine bar weight only (feet forward, tibia perpendicular)
• Lunges
• Stairmaster
• Slideboard
• Sport cord walking (forward, backward, sideways)
• Trampoline (Single leg bouncing, stepping high knee, weight shifting forward, sideways, diagonally)

Patient should obtain full ROM between 8-10 weeks. Self ROM seated and prone should be continued for 6-8 monts to allow full harvest site tissue maturation.

Post-Operative Weeks 12-16:

• Continue with previous program
• Isotonic terminal kne extension, low resistance high repetition
• Theraband slow running low intensity
• Controlled slow forward and backward jogging on level surface
• Trampoline jogging
• Low intensity impact activities (In absence of patella femoral pain or general knee pain. Patient should also have full ROM at this time.) (double leg jumping, sideways jumping, forward jumping, running on spot)
• Functional closed chain evaluation
• At 15-16 weeks, Isokinetic evaluation (In absence of patella femoral pain or general knee pain)

Post-Operative Weeks 16-20:

• Continue with previous program
• Running program if 70% quad stregth per Biodex test and asymptomatic function evaluation. Test speed dependant on sport specfic and symptomatic basis
• Sport specific activities
• Plyometrics medium to high intensity (broad jump, single leg jumping, vertical jumps)
• Agility limits
• Isokinetic evaluation and functional evaluation on a monthly basis until discharge from formal medical care. Patient will be discharged from formal physical therapy with a home program at 20 weeks