Physical Therapy Haven

Phase I: Immediately post-operatively to week 4

• Goals: Protect graft, control inflammation, and patient education on rehab process and restrictions
  • WBAT with bracing and crutches
    • Gradually wean from crutches as tolerated, restore gait to level surfaces
  • Full AROM and PROM of knee extension
• Exercises: Heel slides, quad sets, hamstring curls, closed-chain quadriceps exercises, SLR in all planes, hamstring and calf stretching
• Criteria to move to Phase II: Must be able to achieve full knee extension and minimum of 90° of flexion, normal gait on level surfaces, minimal swelling, and achieves a good quad set

Phase II: Post-operative weeks 4 to 10

• Goals: Protect graft, progress towards full knee flexion, stair training, and hip/quad/hamstring strengthening, increase proprioception
• Exercises: Progress with closed-chain exercises, continue hamstring and calf stretches, stationary biking and Stairmaster training, ROM and flexibility exercises as appropriate, and proprioceptive/balance activities
• Criteria to move to Phase III: No patellofemoral pain, minimum of 120° knee flexion, sufficient strength and proprioception for running, minimal swelling

Phase III: Post-operative weeks 10 to 16

• Goals: Restore full ROM and normal running mechanics, improve strength, endurance and proprioception, protect patellofemoral joint and avoid overstressing graft
• Exercises: Continue flexibility/ROM exercises, hip/quad/hamstring/calf strengthening, CV endurance training, eccentric knee extension exercises, advanced proprioceptive activities, full WB running at 12 weeks
• Criteria to move to Phase IV: No significant swelling, full and pain-free ROM, normal running gait, no patellofemoral joint irritation, sufficient strength/proprioception for agility exercises

Phase IV: Post-operative months 4 through 6

• Goals: Symmetric performance in agility drills, single hop and 3 hop tests 85% of uninvolved lower extremity, quad and hamstring strength 85% of uninvolved lower extremity
• Exercises: Progress with flexibility and strengthening as needed, initiate plyometrics, agility training progressions, and increase running distance as needed
• Criteria to move to Phase V: No patellofemoral or soft tissue complaints, adequate ROM, strength, endurance, and proprioception to return to work/athletics, physician clearance for partial/full activity

Phase V: Approximately 6 months post-op

• Goals: Safe return to work/athletics, maintenance of strength, endurance, ROM, and proprioception, patient education
• Exercises: HEP for strength and endurance, safe return to sports

1. ACL Patella Tendon Autograft Reconstruction Protocol. Brigham and Women's Hospital Web site. http://www.brighamandwomens.org/Patients_Visitors/pcs/rehabilitationservices/Physical%20Therapy%20Standards%20of%20Care%20and%20Protocols/Knee%20-%20ACL%20Patella%20Tendon%20Autograft,%20protocol.pdf.