The Birmingham Sport Injuries Clinic

Dedicated to delivering the highest standards of diagnosis, treatment and rehabilitation for all knee and Shoulder problems

ACL Reconstruction Post‐Operative Rehabilitation Protocol

The following is a generalized outline for rehabilitation following ACL reconstruction. The protocol may be modified if additional procedures, such as meniscus repair or microfracture, were performed.
Phase I: 1 – 14 days Goals
- Protect graft and graft fixation with use of brace and specific exercises 
- Control inflammation and swelling 
- Early range of motion (ROM) with emphasis on full extension, patella mobilizations and flexion Caution: avoid hyperextension greater than 10 degrees
- Educate patient on rehabilitation progression 
- Restore normal gait on level surfaces

Brace – cricket pad splint
- Post‐op brace worn in extension for ambulation and sleeping 
- May remove for ROM exercises

Weightbearing status 
- Partial weightbearing as tolerated with crutches and brace in extension 
- If meniscal repair or microfracture, nonweightbearing for 6 weeks 


- ROM exercises 
Extension – 
- Passive extension – sit in a chair and place your heel on the edge of a stool or chair; relax thigh muscles and let the knee sag under it's own weight until maximum extension is achieved. 
- Heel props – place rolled up towel under the heel and allow leg to relax 
- Prone hangs – lie face down on a table/bed with the legs hanging off the edge of the table; allow the legs to sag into full extension. 
Flexion – limit to 90 degrees for 2 weeks 
- Passive flexion – sit on chair/edge of bed and let knee bend under gravity; may use the other leg to support and control flexion 
- Wall slides – Lie on your back with the involved foot on the wall and allow the foot to slide down the wall by bending the knee; use other leg to apply pressure downward.
Heel slides – Use your good leg to pull the involved heel toward the buttocks, flexing the knee. Hold for 5 seconds; straighten the leg by sliding the heel downward and hold for 5 seconds.
- Quadriceps sets in full extension 
- Straight leg raises in extension 
- Hamstring sets 
- Patella mobilization 
- Isometric hip abduction, adduction 
- Ankle ROM and gastoc‐soleus strengthening with tubing/therabands

Phase II: Weeks 3 – 6 Goals 
- Restore normal gait with stair climbing 
- Maintain full extension, progress toward full flexion range of motion 
- Protect graft and graft fixation 
- Increase hip, quadriceps, hamstring and calf strength 
- Increase proprioception 
- Remove brace when demonstrate good quad control

Weightbearing status 
- Weightbearing as tolerated, wean off crutches

- Continue as above, maintaining full extension and progressing to 125 degrees
- Begin closed kinetic chain exercises 
- Hamstring curls 
- Hip abduction, adduction, extension 
- At 4‐ 6 weeks, 1⁄4 partial squats, use table for support

Phase III: Weeks 6 – 12 Goals 
- Full active range of motion 
- Increase strength Exercises 
- Stationary bicycling, stairmaster, elliptical: increases resistance 
- Treadmill walking 
- Swimming, water conditioning: flutter kick only 
- Balance and proprioceptive training 
- Closed chain quad strengthening: no knee flexion greater than 90 degrees with leg press 

Phase IV: Months 3 – 6 Goals
- Improve strength, endurance and proprioception 
- May start jogging program, forward/straight running only 
- Continue and progress strengthening 
- Progress to running program at 5 months 
- Begin agility training at 5 months 
Side steps Crossovers Figure8running Shuttlerunning Onelegandtwolegjumping Cutting Acceleration/deceleration/sprints Agilityladderdrills
- Initiate sport‐specific drills as appropriate

Phase V: 6 months post‐op
- Maintain strength, endurance and proprioception 
- Gradual return to sports participation 
- Maintenance program for strength, endurance

Return to sports criteria 
- Surgeon clearance 
- Full range of motion 
- No swelling 
- Good stability on ligament testing 
- Full strength compared to other leg 
- Completed sport‐specific functional progression 
- Running and jumping without pain or limp 

Appointments: 07515 113 915

The sport injuries clinic (Midlands) Ltd trading as The sport injures clinic.