https://docs.google.com/spreadsheets/d/1Movll-tBRs10XntYIWgUR-H3vGygGD7u_zSDd4wJfus/edit?usp=drivesdk
https://docs.google.com/spreadsheets/d/1Movll-tBRs10XntYIWgUR-H3vGygGD7u_zSDd4wJfus/edit#gid=0
Phase 1
Phase 2
swelling tests
Post-Op Rehab Overview
| Phase | UDelaware protocol goals | Dwyer's Goals | Fowler Kennedy protocol goals | MOON research group Criteria to pass | Exercises | Notes |
|---|---|---|---|---|---|---|
| Phase 1 | ||||||
| 0-2 weeks | At least 0° knee extension ROM |
You can bend your knee (flexion) to at least 110 degrees.
Your quadriceps muscle is contracting with strength. For example, you can do 20 straight leg raises without difficulty. | Straight leg raise Quads set Work on full extension Passive leg hangs to 90° Active range to 90° degrees Other exercises | Weight bearing Progress to full Crutches typically used for 1 – 2 weeks
Brace in extension for walking and sleeping Gameready
ROM progress as much as possible | | Phase 2 2 – 6 weeks
You can drive now! | - Continue progressive impairment resolution
Normalize gait
SLR without a lag
Progressive quadriceps strengthening
Restoration of full ROM
Resumption of ADLs | Progress your knee to full range of motion.
Continue to improve muscle strength with increasing resistance in your exercises.
Begin to resume your normal daily living activities. These include walking, standing, using stairs and getting in and out of a car. | Achieve near or full ROM in knee flexion and extension
Continue flexibility exercises of other joints
Continue strengthening exercises with control: hip, hamstrings, quadriceps, calves
Strengthen non injured leg (documented strength losses in unaffected limb)(22)
Progress proprioception
Normal WB gait
Maintain cardiovascular fitness | The range of motion of your surgical leg is full and equal to your non-injured leg.
You can do normal daily living activities without difficulty or favoring your injured leg. These include walking, standing, going up and down at least a dozen steps, and getting in and out of a car.
You’re ready to increase resistance in your strength exercises through weights and bands.
You can do a double leg squat down to at least 60 degrees at the knee with equal weight on both legs with proper mechanics.
Your self-assessment score is 7 or higher on IKDC question 10 (see self-assessment below). | As above Progress to achieve full flexion actively Passive extension to 0 Avoid forced passive flexion Bike daily for 30 minutes Begin closed chain extension exercises Balance exercises ice, elevate, compress after exercise Other exercises
Complete every hour or 5x a day | Full weight bearing
No brace needed
Progress to full ROM Must have full extension Must have 90° flexion by week six
(Week 4 to 6: Full (130 to 140 degrees) knee bending is achieved in 4 to 6 weeks. There is a 6-week mark post-surgery when knee bending becomes easy. If the full functionality is not restored within six (6) weeks, it becomes difficult to repair or recondition the tissues of your knee. | | Phase 3 6 – 12 weeks
Cycle outdoors? Swim? Week 6 | - Improve tolerance to loading
Initiate transition to gym-based program and/or supervised training with ATC or strength coach if appropriate | Maintain full range of motion equal to your other leg with minimal to no swelling or pain. Being able to bend your reconstructed knee the same amount as the non-surgical knee is critical.
Continue to increase the strength of your surgical leg to 70 to 75 percent of the strength of your non-surgical leg by increasing exercise resistance.
Continue to improve single-leg balance (which is harder than it sounds) and improve motor control. You may be measured using the STAR or Y Balance Test™, which requires specialized equipment.
Do single and double leg hopping in place with proper mechanics and no pain.
Add sports-specific activities as you can tolerate. | 6-9 weeks: Full and pain free knee range of motion Functional quadriceps strength Initiate isokinetic quadriceps strengthening in a specific & limited range(37) **only if: ROM is full, no swelling, adequate muscle control, and no meniscal or patellofemoral pathology Address documented quadriceps strength deficits (high and low velocity, concentric and eccentric, 0-95°)(23) Continue strengthening lower extremity muscle groups, specifically through full range hamstrings/quadriceps (without pain at donor site) Advance proprioception exercises Increase cardiovascular fitness
9-12 weeks: Continue flexibility exercises Quadriceps strength progression Address documented hamstring strength deficits (high speed, eccentric 95-60°)(23) Continue lower chain concentric/eccentric strengthening of quadriceps & hamstrings, both inner range (60– 95°) & full range Proprioceptive progression Sport specific cardiovascular fitness | evaluation | Body squats and lunges to 90° Advance closed chain exercises such as leg press, weighted squat machine, lunges – light weight, high reps
Other exercises | Full weight bearing
No brace
Full rom | | **** Phase 4 12 – 24 weeks / 3 - 6 months | | you first walk, jog and then run. The goal is to retrain your running form and technique before any cutting or change of direction.
In most cases, your physical therapist or athletic trainer will move you from slow walking on a treadmill to jogging to running. You’ll increase speed, time and distance as you progress.
Next will be running off the treadmill. This includes straight-line jog-runs on even surfaces like a track.
All this prepares your body for more advanced movements like jumping and cutting.
| | evaluation by physio - Mitch? | Single leg strength Begin elliptical at 3 months Begin stairmaster at 4 months Begin jogging in straight line at 5 months
Introduce jumping and landing | Full weight bearing No brace Full rom | | **** Phase 5 24 weeks / 6 months | | Add start-stop, cutting and deceleration exercises Progress your running to wide S-curves and figure-eight patterns Do 45-degree cuts Begin single leg plyometrics hopping with functional movements Do pivoting, direction change and deceleration exercises Move from planned movement patterns to unplanned movement patterns often called reaction drills. | | evaluation by physio - Mitch? | At 6 months, begin jumping /cutting / pivoting / change in direction / sprinting Full sporting activities allowed after nine month review Must have strength deficit < 5% in comparison to other leg Must have no swelling | Full weight bearing No brace Full rom |
[A Ten Task-Based Progression In Rehabilitation After ACL Reconstruction: From Post-Surgery To Return To Play – A Clinical Commentary](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735691/#:~:text=The ten tasks progressions after,sport-specific change of direction.)
| Task No | Task group | Exercise Name/ target movement | Required strength to allow unrestricted practice of task | Required knee range of motion |
|---|---|---|---|---|
| 1 | Walking | Walking with no limp unaided (e.g., without crutches) | Good quad recruitment | Full knee extension |
| 2 | Bilateral foundation movements | Bilateral squat to 90 ° with less than 20% asymmetry in limb loading | 50% BM single limb leg press | Full knee extension/ flexion > 90 ° |
| 3 | Unilateral foundation movements | Single leg squat to 90 ° | 80% BM single limb leg press | > 120 ° flexion |
| 4 | Bilateral landing | Bilateral landing control from sub-maximal jump | 100% BM single limb leg press and/or 150% BM double limb leg press/squat | > 130 ° flexion |
| 5 | Running | Treadmill running at 8 km.h-1 | 125% BM single limb leg press/squat and/ or Isometric knee extension > 70% LSI | > 130 ° flexion |
| 6 | Bilateral plyometrics | 30 cm bilateral drop jump | >80% LSI knee extension and 125% BM single limb leg press/squat or 200% BM single limb leg press/squat | Full |
| 7 | Unilateral jumping/ landing | Single leg deceleration from forward and lateral running | >80% LSI isokinetic knee extension and/or 150% BM single limb leg press/squat | Full |
| 8 | Unilateral plyometrics | Single leg drop jump | As above | Full |
| 9 | Pre-planned multi-directional movements | 90 ° cut maneuver | As above | Full |
| 10 | Sport-specific movements | 45 ° re-active change of direction | >90% LSI isokinetic knee extension and/or 200% BM single limb leg press/squat | Full |
Delaware Physical Therapy Clinic_ACL Return to Sport Guidelines in DETAIL.pdf
PHYSIOTHERAPY-FOLLOWING-ACL-RECONSTRUCTION-PROTOCOL-November-2015.pdf