ACL Rehab Program

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Bracing

1. Lock at 20° for one week (non weight-bearing and no ROM).
2. Shower without brace at one week.
3. Sleep without brace at four weeks. st
4. Set brace at 10°-120° for ambulation and ADLs (activities of daily living) during 1 month.
5. Set brace at 20°-100° for rehab exercises during 1st month.
6. Discontinue brace at five to six weeks with adequate quad strength.
7. Continue brace for rehab exercises if needed.
8. Remove brace for stationary biking.
9. May perform selected rehab exercises without brace under supervision of PT and in controlled setting.

ROM/ Strengthening

1. 1. Immediate isometric ham/quad co-contractions.
   2. Passive ROM 0-135° (avoid hyperextension).
   3. Safeguarded CKC (closed kinetic chain) exercises 20°-100° in rehab brace.

Recommended:

1. 1. Squats
   2. Seated toe drags
   3. Toe raises
   4. Treadmill walking (inclines)
   5. Biking with toe clips
   6. Pilates
   7. Total Gym
   8. Elliptical Trainer
   9. Leg Press
2. Incorporate single leg strengthening, balance, and proprioceptive exercises once good eccentric quad control is established.
3. Incorporate aquatic therapy where available once incision is well healed and sealed.

Goals

1. 0°-135° ROM by four to eight weeks.
2. Quad/ham strength 80-85% contralateral (opposite) limb by four months.
3. Sports brace with 20° extension stop at five to six months or once quad strength is sufficient.
4. Sports specific training at five months with sports brace.
5. Return to sport at six months in sports brace.
6. Run/jog program at 3-4 months upon physician approval.

Troubleshooting/ Specific Needs

1. With meniscal repair:
   1. Lock brace at 20° for two weeks (increase weight-bearing at 2 weeks post-op).
   2. Set brace at 20°-90° for exercise.
2. With microfracture/mosaicplasty, see prescription for weight bearing timing.
3. Hyperlax patient:
   1. Set brace at 30°-100° for exercise.
   2. Avoid hyperextension with passive ROM.
4. Slow extension:
   1. Adjust brace setting to 10°-100° for exercise
   2. Patellar glides
   3. Extension sitting
   4. Prone extension
   5. Long striding gait
   6. Stretch gastroc/hams 5 times a day
   7. Remove brace for safe ADLs (optional)
   8. Remove brace for passive ROM exercises
   9. Soft tissue work to posterior musculature.

• Slow flexion:
  1. Patellar glides
  2. Wall slides
  3. Chair squats
  4. Kneeling squats
  5. Cycling
  6. Remove brace for passive ROM exercises
  7. Scar Mobilization
  8. Retro-treadmill walking