Orthopaedic Surgeon
ACL Reconstruction BTB or Quad Tendon Surgical Rehabilitation
PHASE I - IMMEDIATE POST‑OPERATIVE PHASE
POD 1
Weight Bearing: Two crutches as tolerated
Exercises: * Ankle pumps
* Passive knee extension to zero
* Straight leg raises
* Quad sets, glut sets
* Hamstring stretch
Muscle
Stimulation: Muscle stimulation to quads (4 hours per day) during quad sets
Passive ROM, zero to 90 degrees as tolerated (as directed by physician)
Ice and
Elevation: Ice 20 minutes out of every hour and elevate with knee in extension
POD 2 to 3
Weight Bearing: Two crutches, weight bearing as tolerated
Range of Motion: Patient out of brace 4‑5 times daily to perform self ROM
Exercises: * Multi-angle isometrics at 90 and 60 degrees (for quads)
* Knee Extension 90-40 degrees
* Intermittent ROM exercises continued
* Patellar mobilization
* Ankle pumps
* Straight leg raises (multi-plane)
* Standing weight shifts and mini squats [(0‑30) ROM]
* Hamstring curls
* Continue quad sets/glut sets
Muscle
Stimulation: Optional electrical muscle stimulation to quads (6 hours per day)
Ice and
Elevation: Ice 20 minutes out of every hour and elevate with knee in extension
POD 4 to 7
Weight Bearing: Two Crutches weight bearing for three weeks
Range of Motion: Patient out of brace or in PRS to perform ROM 4‑5 times daily
Exercises: * Knee Extension 90-40 degrees
* Intermittent PROM exercises
* Patellar mobilization
* Ankle pumps
* Straight leg raises (multi-plane)
* Standing weight shift and mini squats (0‑30)
* Passive knee extension to 0 degrees
* Hamstrings curls
* Proprioceptive and balance activities
Muscle
Stimulation: Electrical muscle stimulation in PT, zero to 90 degrees PRN
PHASE II - MAXIMUM PROTECTION PHASE (Week 2‑3)
Criteria to Enter Phase II
1) Quad Control (ability to perform good quad set and SLR)
2) Full passive knee extension
3) PROM 0-90 degrees
4) Good patellar mobility
5) Minimal effusion
6) Independent ambulation with one or two crutches
Goals: Absolute control of external forces and protect graft
Nourish articular cartilage
Decrease fibrosis
Stimulate collagen healing
Decrease swelling
Prevent quad atrophy
A: Week Two
Goals: Prepare patient for ambulation without crutches
Weight Bearing: Weight bearing as tolerated
Range of Motion: Self ROM (4-5 times daily), emphasis on maintaining zero degrees passive extension
Exercises: * Muscle stimulation to quadriceps during quadriceps exercises
* Multi‑angle isometrics at 90, 60, 30 degrees
* Leg raises (4 planes)
* Hamstring curls
* Knee extension 90‑40 degrees
* Mini squats (0‑40) and weight shifts
* PROM 0‑105 degrees
* Patellar mobilization
* Hamstring and calf stretching
* Proprioception training
* Well leg exercises
* Progressive Resistive Exercise Program ‑ start with 1 lb, progress 1 lb per week
Swelling control: Ice, compression, elevation
B: Week Three
Range of Motion: Self ROM (4‑5 times daily), emphasis on maintaining zero degrees passive extension
Weight bearing: Weight bearing as tolerated
Exercises: * Same as week two
* PROM 0‑115 degrees
* Bicycle for ROM stimulus and endurance
* Pool walking program
* Initiate eccentric quads 40‑100 (isotonic only)
* Leg press (0‑60)
* Stair climber
* Elliptical
PHASE III - CONTROLLED AMBULATION PHASE (Week 4‑7)
Criteria to Enter Phase III
* AROM 0‑115 degrees
* Quad strength 60 % > contralateral side (isometric test) (60 degree knee flexion angle)
* Minimal effusion
Goals: Weight bearing as tolerated
Range of Motion: Self ROM (4-5 times daily), emphasis on maintaining zero degrees passive extension
Exercises: * Same as week three
* PROM 0 ‑ 130 degrees
* Initiate swimming program
* Initiate step‑ups (start with 2" and gradually increase)
* Increase closed kinetic chain rehab
* Increase proprioception training
PHASE IV - MODERATE PROTECTION PHASE (Week 7‑12)
Criteria to Enter Phase IV
* AROM 0‑125 degrees
* Quad strength 60 % of contralateral leg (isokinetic test)
* No change in KT scores (+2 or less) or manual exam
* Minimal effusion
* No patellofemoral complaints
* Satisfactory clinical exam
Goals: Protect patellofemoral joint's articular cartilage
Maximal strengthening for quads, lower extremity
Isokinetic Test: (Week 10)
Exercises: * Emphasize eccentric quad work
* Continue closed chain exercises, step‑ups, mini‑squats, leg press
* Continue knee extension 90‑40 degrees
* Hip abduction/adduction
* Hamstring curls and stretches
* Calf raises
* Bicycle for endurance
* Pool running (forward/backward)
* Walking program
* Stair climber
* Initiate isokinetic work 100‑40 degrees
PHASE V - LIGHT ACTIVITY PHASE (Month 2 ½ ‑ 3 ½)
Criteria to Enter Phase V
* AROM 0‑125 degrees >
* Quad strength 70 % of contralateral side, knee flexor/extensor rated 70‑79%
* Minimal/no effusion
* Satisfactory clinical exam
Goals: Development of strength, power, and endurance
Begin to prepare for return to functional activities
Tests: Isokinetic test (week 10‑12 and 16‑18) if available
Exercises: * Continue strengthening exercises
* Initiate plyometric program
* Initiate running program
* Initiate agility drills
* Sport specific training and drills
Criteria to initiate running program
* Satisfactory isokinetic test
* Functional test 70% > contralateral leg
* Satisfactory clinical exam
PHASE VI - RETURN TO ACTIVITY PHASE (Month 3 ½ ‑ 4 ½)
Criteria to return to activities
* Isokinetic test that fulfills criteria if available
* Functional test 85% > contralateral leg
* Proprioceptive test 100% of contralateral leg
* Satisfactory clinical exam
Goals: Achieve maximal strength and further enhance neuromuscular coordination and endurance
Tests: Isokinetic test prior to return, functional test
Exercises: * Continue strengthening program
* Continue closed chain strengthening program
* Continue plyometric program
* Continue running and agility program
* Accelerate sport specific training and drills
6 MONTH FOLLOW‑UP
Isokinetic test if available
Functional test
12 MONTH FOLLOW‑UP
Isokinetic test if available
Functional test