ACL Rehabilitation Guidelines

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Download printable ACL Rehabilitation Guidelines

The rehabilitation guidelines contained in this document have been created and approved by the physicians and rehabilitation staff of Agility Orthopedics. There is an expectation that patients will only be advanced beyond the timelines designated in this document with the written permission of the physician. Also, physicians should be notified immediately if patients are not progressing according to the described timelines.

Immediate Post-Op

  • Bledsoe/Don Joy brace locked at 0 degrees.
  • Cryocuff incorporated in brace with compressive wrap.
  • Isometric quads at >45 degrees.
  • Weight bearing as tolerated (except with mensical repair).
  • With meniscal repairs the patient will be non-weight bearing for 4 to 6 weeks and limit flexion to 90º for the first 4 weeks.
  • Home Exercise Program 2-3 times per day:
    • Ankle pumps with towel
    • Quad sets at 0º
    • Straight leg raise
    • Quad sets at greater than 45º
    • Co-contractions (Quad/Ham set)
    • Isometric hamstring set
    • Passive knee flexion off the side of the bed
    • Prone knee extension stretch

Days 3-4 to Weeks 2-3

  • CPM (optional) for home use (2 hours, 3 times per day at slow speed for 2 weeks). Increase flexion 10 degrees per day to 90º, then increase in 5º increments as tolerated.
  • ROM Goal: 0º extension and 100º flexion (emphasis on full extension).
  • Outpatient Physical Therapy: Three times per week.
  • Use compressive stockings until follow up appointment (10-14 days).
  • Continue use of Cryocuff as needed.
    • Home Exercise Program 3 times per day:
    • Towel extensions
    • Prone passive stretching (if necessary for extension)
    • Wall and heel slides for flexion
    • Isotonic hamstrings
    • Open chain quads 90-45º
    • Good leg assist passive extension

Weeks 3-6

  • Fit with ACL Functional Brace with 0 to 100º minimum. Exception: Meniscal repairs stay in Bledsoe/Don Joy Brace for 6 weeks.
  • Wean down to one crutch or cane.
  • Should have 120 degrees of knee flexion and full knee extension.
  • Swimming with well leg kick only.
  • Stationary biking ROM/light resistance, stepping, 1/4 squats.
  • Start closed chain quad exercises.