ACL RECONSTRUCTION PROTOCOL

ACL RECONSTRUCTION PROTOCOL(+/- Meniscus Repair)Raj Bazaz, MD(303) 321-1333 orToll free 1-888-900-1333 (outside Denver)www.western-ortho.comThis protocol is based on goal-oriented progression. Each patient is different andshould be treated according to their tolerance in therapy. Please feel free to callwith any questions.Phase I: (0-6 weeks)Goals:Alleviate acute pain and swellingIncrease ROM 0-90 degrees (emphasize 0 degrees extension). Mayadvance past 90 degrees flexion if no meniscus repair performed.Increase hamstring and quadriceps strengthPromote comfortable ambulation WBAT with brace and crutchesMaintain cardiovascular conditioningPlan: (0-2 weeks)Patellar mobilizationPROM positioning for knee extensionROMHeel/wall slides w/o brace½ revolution non-resisted bike for knee flexion-progress to full revolutionwhen patient reaches 110 degreesHamstring and quadriceps co-contraction4-Quad (hip flexion, abduction, adduction, extension)Modalities for pain and edema control(2-6 weeks)Plan:Soft tissue/scar mobilizationProne/standing knee flexionProprioceptive training/balance-BAPS, trampolineWeight shifting in standing, 0-30 degrees ROM mini-squatsEMS co-contraction at VMO and hamstringsTheraband ankle exercises-progress to standing as WB dictatesBegin Stairmaster at 4 weeks (may need to delay if patellar tendonautograft)General conditioningAquatic therapy (when incisions healed) No whip kick

Phase II (6-12 weeks)Goals:Decrease swelling and prevent atrophyIncrease ROM 0-full flexionIncrease quadriceps and hamstring strengthIncrease hip strengthStimulate collagen healingIndependent ambulation without crutchesContinue general conditioningPlan:Continue phase I exercisesContinue patellar mobilization and ROM activities as objective findingswarrantStanding ½ squatJoint and soft tissue mobilization as neededIsotonic hamstring NK tableLeg pressContinue closed chain, balance and proprioceptive activitiesContinue EMS as needed for muscle re-ed and edemaStep-ups (controlled-forward and side)*McConnell taping as necessaryGeneral conditioningPhase III (12-16 weeks)Goals:Full ROMContinue all goals from Phase IIPlan:Continue phase II exercises and progress as toleratedStep-up- side and downIncrease proprioceptive training (sport cord, body blade, plyoballs)Treadmill as toleratedContinue Stairmaster½ wall sits as tolerated(16-20 weeks)Plan:Light jogging on trampoline¼ to ½ squats (painfree)Progress with closed chain activityIsotonic terminal knee extension (30-0 degrees)

Phase IV (20-36 weeks)Goals:Development of strength, power and enduranceBegin to prepare for return to recreational activityBegin sport specific trainingPlan:Continue Phase III exercises and conditioning activitiesContinue strength trainingInitiate running programInitiate agility drillsSport specific training and drillsIsokinetic evaluation (please perform at about 6 months)