ACL Reconstruction
Rehabilitation Protocol
Ira K. Evans, M.D.
Sports Medicine North
Orthopedic Specialty Center
One Orthopedics Drive
Peabody, MA 01960
Tel: (978) 818-6350
Fax: (978) 818-6355
www.sportsmednorth.com
, ACL Reconstruction Rehabilitation Protocol
Table of Contents
Preoperative Rehabilitation Phase ...................................................................................... 3
Postoperative Days 1-7 ....................................................................................................... 9
Postoperative Days 8-10 ................................................................................................... 14
Postoperative Week 2 ....................................................................................................... 15
Postoperative Weeks 3-4 .................................................................................................. 17
Postoperative Weeks 4-6 .................................................................................................. 18
Postoperative Weeks 6-12 ................................................................................................ 19
Postoperative Weeks 12 - 20 ............................................................................................ 19
24 Weeks Postoperative (6 months) ................................................................................. 20
Medication Regimen ......................................................................................................... 20
Frequently asked Questions ........................................................................................ 21-23
List of Figures
Figure 1: Heel prop using a rolled towel .............................................................................. 4
Figure 2: Prone Hang. Note the knee is off the edge of the table ....................................... 5
Figure 3: Wall Slide: Allow the knee to gently slide down ................................................... 5
Figure 4: Heel slide - leg is pulled toward the buttocks ....................................................... 6
Figure 5: Heel slides in later stages of rehabilitation ........................................................... 6
Figure 6: Stationary Bicycle helps to increase strength ...................................................... 7
Figure 7: Use the non-injured leg to straighten the knee .................................................. 11
Figure 8: Passive Flexion allowing gravity to bend the knee to 90 degrees ...................... 11
Figure 9: Straight leg raises - lying (left) and seated (right) .............................................. 13
Figure 10: Partial squat using Table for stabilization ......................................................... 15
Figure 11: Toe Raise ........................................................................................................ 16
Figure 12: Leg press using 90-0 degree range ................................................................. 18
2
, Sports Medicine North/Orthopedic Specialty Center
ACL Reconstruction Rehabilitation Protocol
One of the most common complications following ACL reconstruction is loss of motion,
especially loss of extension. Loss of knee extension has been shown to result in a limp,
quadriceps muscle weakness, and anterior knee pain. Studies have demonstrated that the
timing of ACL surgery has a significant influence on the development of postoperative
knee stiffness.
THE HIGHEST INCIDENCE OF KNEE STIFFNESS OCCURS IF ACL SURGERY IS
PERFORMED WHEN THE KNEE IS SWOLLEN, PAINFUL, AND HAS A LIMITED
RANGE OF MOTION.
The risk of developing a stiff knee after surgery can be significantly reduced if the surgery
is delayed until the acute inflammatory phase has passed, the swelling has subsided, a
normal or near normal range of motion (especially extension) has been obtained, and a
normal gait pattern has been reestablished.
Preoperative Rehabilitation Phase
Prepare for surgery using the information within this section.
Goals: *Control pain and swelling
*Restore normal range of motion
*Develop muscle strength sufficient for normal gait and ADL
*Mentally prepare the patient for surgery
Before proceeding with surgery the acutely injured knee should be in a quiescent state
with little or no swelling, have a full range of motion, and the patient should have a normal
or near normal gait pattern.
More important than a predetermined time before performing surgery is the condition of
the knee at the time of surgery. Use the following guidelines to prepare the knee for
surgery:
Immobilize the knee
Following the acute injury you should use a knee immobilizer and crutches until you
regain good muscular control of the leg. Extended use of the knee immobilizer should be
limited to avoid quadriceps atrophy (weakness). You are encouraged to bear as much
weight on the leg as is comfortable unless otherwise directed by your physician.
3
Rehabilitation Protocol
Ira K. Evans, M.D.
Sports Medicine North
Orthopedic Specialty Center
One Orthopedics Drive
Peabody, MA 01960
Tel: (978) 818-6350
Fax: (978) 818-6355
www.sportsmednorth.com
, ACL Reconstruction Rehabilitation Protocol
Table of Contents
Preoperative Rehabilitation Phase ...................................................................................... 3
Postoperative Days 1-7 ....................................................................................................... 9
Postoperative Days 8-10 ................................................................................................... 14
Postoperative Week 2 ....................................................................................................... 15
Postoperative Weeks 3-4 .................................................................................................. 17
Postoperative Weeks 4-6 .................................................................................................. 18
Postoperative Weeks 6-12 ................................................................................................ 19
Postoperative Weeks 12 - 20 ............................................................................................ 19
24 Weeks Postoperative (6 months) ................................................................................. 20
Medication Regimen ......................................................................................................... 20
Frequently asked Questions ........................................................................................ 21-23
List of Figures
Figure 1: Heel prop using a rolled towel .............................................................................. 4
Figure 2: Prone Hang. Note the knee is off the edge of the table ....................................... 5
Figure 3: Wall Slide: Allow the knee to gently slide down ................................................... 5
Figure 4: Heel slide - leg is pulled toward the buttocks ....................................................... 6
Figure 5: Heel slides in later stages of rehabilitation ........................................................... 6
Figure 6: Stationary Bicycle helps to increase strength ...................................................... 7
Figure 7: Use the non-injured leg to straighten the knee .................................................. 11
Figure 8: Passive Flexion allowing gravity to bend the knee to 90 degrees ...................... 11
Figure 9: Straight leg raises - lying (left) and seated (right) .............................................. 13
Figure 10: Partial squat using Table for stabilization ......................................................... 15
Figure 11: Toe Raise ........................................................................................................ 16
Figure 12: Leg press using 90-0 degree range ................................................................. 18
2
, Sports Medicine North/Orthopedic Specialty Center
ACL Reconstruction Rehabilitation Protocol
One of the most common complications following ACL reconstruction is loss of motion,
especially loss of extension. Loss of knee extension has been shown to result in a limp,
quadriceps muscle weakness, and anterior knee pain. Studies have demonstrated that the
timing of ACL surgery has a significant influence on the development of postoperative
knee stiffness.
THE HIGHEST INCIDENCE OF KNEE STIFFNESS OCCURS IF ACL SURGERY IS
PERFORMED WHEN THE KNEE IS SWOLLEN, PAINFUL, AND HAS A LIMITED
RANGE OF MOTION.
The risk of developing a stiff knee after surgery can be significantly reduced if the surgery
is delayed until the acute inflammatory phase has passed, the swelling has subsided, a
normal or near normal range of motion (especially extension) has been obtained, and a
normal gait pattern has been reestablished.
Preoperative Rehabilitation Phase
Prepare for surgery using the information within this section.
Goals: *Control pain and swelling
*Restore normal range of motion
*Develop muscle strength sufficient for normal gait and ADL
*Mentally prepare the patient for surgery
Before proceeding with surgery the acutely injured knee should be in a quiescent state
with little or no swelling, have a full range of motion, and the patient should have a normal
or near normal gait pattern.
More important than a predetermined time before performing surgery is the condition of
the knee at the time of surgery. Use the following guidelines to prepare the knee for
surgery:
Immobilize the knee
Following the acute injury you should use a knee immobilizer and crutches until you
regain good muscular control of the leg. Extended use of the knee immobilizer should be
limited to avoid quadriceps atrophy (weakness). You are encouraged to bear as much
weight on the leg as is comfortable unless otherwise directed by your physician.
3
