ACL Reconstruction Rehabilitation Protocols

55 ACL Reconstruction rehabilitation protocols from 25 institutions, published 2003–2025. Weight-bearing progressions vary by institution — compare them in the table below before selecting a protocol.

Institution	Weight-Bearing	Key Restrictions
Brigham and Women's Hospital — All Graft Types	Per graft type: BPTB WBAT; Hamstring PWB initially; Allograft more conservative; meniscal…	BPTB: increased anterior knee pain with kneeling; Hamstring: no resisted hamstring x 12 wks; Allograft…
Brigham and Women's Hospital — Allograft	TDWB x 2 wks; PWB wks 2-4; WBAT wks 4-6; crutches and brace x 6 wks	Allograft revascularization slower than autograft; crutches and brace continued x 6 wks; brace locked ext x 1…
Brigham and Women's Hospital — BPTB Autograft	WBAT immediately with crutches and brace	Brace locked in ext for sleep x 1 wk; brace locked for ambulation until full ext with good quad control…
Brigham and Women's Hospital — Hamstring Autograft	PWB with crutches (0-1 wk); progress to FWB by 4 wks	Protect graft revascularization (8 wks) and fixation (8-12 wks); flex to 90 deg only Phase I; avoid hyperext…
Dr. Brian Cole MD (Rush University Medical Center) — BPTB…	WBAT with crutches (Phase I); gradually D/C crutches (Phase II)	Brace locked full ext for ambulation and sleeping x 1 wk; unlocked wks 1-4; D/C brace when full ext and no…
E&B Orthopedics — with Medial Meniscus Repair	TTWB with crutches and LROM brace locked in full ext (0-6 wks); progress after 6 wks	LROM brace locked at 0 deg for sleeping and walking; no flex past 90 deg x 6 wks; no pillows under knee; BFR…
Mammoth Orthopedic Institute / Sierra Park PT — ACL with Quad…	TTWB with crutches x3 weeks; progressing to 50% PWB x6 weeks; DC crutches after 6 weeks…	TTWB x3 weeks then 50% PWB x6 weeks (more restrictive than standard ACL due to ALL reconstruction); brace…
Mammoth Orthopedic Institute / Sierra Park PT — Hamstring…	PWB with 2 crutches x1 week; FWB with crutches wks 1-4 (progress as quad control and…	Brace locked in extension until 1st PT visit; wks 1-3 unlock to 90 deg as quad control allows; avoid…
Mammoth Orthopedic Institute / Sierra Park PT — Quad Tendon…	WBAT with crutches; DC crutches when quad control returns and full extension achieved…	Brace locked in extension until 1st PT visit; no open chain resistive with weights (bands OK); no downhill…
Mammoth Orthopedic Institute / Sierra Park PT — with Quad…	WBAT with crutches (brace locked 0° extension) x6 weeks; DC crutches when quad control…	Flexion limited to 90 deg x6 weeks (meniscal repair); brace locked 0° for ambulation x6 weeks; no open chain…
Massachusetts General Hospital — Allograft	PWB with crutches x 6 wks (unless otherwise instructed by MD)	Same as BPTB plus: PWB with crutches x 6 wks; early return to sport phase delayed; allograft…
Massachusetts General Hospital — BPTB Autograft	WBAT initially with brace locked and crutches; may walk without crutches when no…	Brace locked initially, unlock once SLR without lag; D/C brace after 6 wks per MD; no towel under knee; no…
Massachusetts General Hospital — Hamstring Autograft	PWB with crutches x 6 wks (unless otherwise instructed by MD)	Same as BPTB plus: no resisted hamstring strengthening until 12 wks; PWB with crutches x 6 wks; early return…
Massachusetts General Hospital — Pediatric	WBAT with brace locked and crutches initially; allograft/hamstring autograft: PWB x 6 wks	Brace locked initially; unlock brace once SLR without lag; DC brace at 6 wks per MD; allograft/hamstring: PWB…
MOON Group (Multicenter Orthopaedics Outcomes Network) — MOON…	WBAT with crutches beginning day of surgery; D/C crutches when normal gait and safe stair…	No immobilizer (except first 24 hrs after femoral nerve block); progression is criterion-based not…
Mountain Orthopaedics — (BTB - Bone-Tendon-Bone)	WBAT with crutches wk 1 (balance only); encourage FWB ASAP; advance per tolerance	Knee immobilizer 48 hrs only (exception: concomitant MCL tear); avoid all open chain x 12 wks; open chain max…
Mountain Orthopaedics — (Hamstring Graft)	WBAT with crutches wk 1 (balance only); encourage FWB ASAP; advance per tolerance	Knee immobilizer 48 hrs only (exception: concomitant MCL tear); avoid all open chain x 12 wks; open chain max…
NYU Langone Health — and Meniscus Repair	NWB/TDWB	TDWB (0%) 0-2 wks; brace locked in extension for ambulation/sleep 0-4 wks, unlocked 4-6 wks; no flexion >90…
NYU Langone Health — Isolated ACL Reconstruction	WBAT	WBAT from day 1 with brace locked at 0 for ambulation/sleep; emphasis on full extension throughout; wean…
Ohio State University Wexner Medical Center — Hamstring…	Criterion-based AD discharge (same criteria as OSU quad tendon protocol)	No isotonic resisted hamstring exercises x 8 wks; no loaded OKC ext beyond 45 deg x 8 wks; no forced flex…
Ohio State University Wexner Medical Center — Quad Tendon…	Criterion-based AD discharge (full active ext, strong quad iso, 2x10 SLR without lag…	No forced flex past 90 deg for meniscus repairs; ACLR with meniscectomy can push for symmetrical flex…
Orthopaedic Associates of Maine	WBAT; crutch-assisted until minimal limp; brace 1-2 wks	No resisted leg extension machine at any point; if hamstring graft: no isolated hamstring until 3 wks, no…
Orthopaedic Associates of Maine — with Complex Meniscus Repair	NWB 3-4 wks; knee immobilizer 4 wks	NWB 3-4 wks; knee immobilizer 4 wks; CKC between 20-70° or full extension only; avoid submaximal CKC 8 wks…
Orthopaedic Associates of Maine — with Simple Meniscus Repair	TDWB 3-5 days, then FWB in extension; knee immobilizer 3 wks	Knee immobilizer 3 wks; TDWB 3-5 days; CKC 20-70° or full extension only; avoid submaximal CKC 6 wks; active…
Orthopedic & Sports Medicine Specialists (OSMS)	Toe-touch WB in locked brace at 0 deg Phase I (brace worn 3 wks locked in extension while…	No ligament stability testing (Lachman, A/P drawer, varus/valgus stress) before 12 wks; avoid isotonic…
Orthopedic & Sports Medicine Specialists (OSMS) — with MCL…	NWB with locked brace in extension Phase I (2 wks); TWB to 50% WB with crutches Phase II…	Brace locked for ambulation/sleeping Phase I; ROM 0-90 deg Phase I with emphasis on full extension and…
Saint Louis University (SLUCare)	WBAT week 1; gait without crutches by week 2; brace and graft type per surgeon	If meniscal repair: brace locked at 0 deg until week 5; no loaded knee flexion >45 deg until week 5; no…
SAM Health — (Skeletally Mature Athlete)	Crutches initially; stable meniscus: NWB 0-2 wks, 50% WB 2-4 wks; unstable…	Graft-specific milestones; NMES for quad; BFR Phase III+; dual-task training; no RTS <9-12 months
Sanford Health — ACL Reconstruction	WB immediately in locked brace; crutches x 7-14 days as needed	Drop lock brace x 6 wks; OKC knee extension 90-45° starting at 4 wks (progress 10°/wk); no impact until full…
SOMOS (Society of Military Orthopaedic Surgeons) — Isolated…	WBAT; brace locked 0° for WB activity until 20 SLRs without extension lag; D/C crutches…	Brace locked 0° for WB until 20 SLRs without lag; no OKC strengthening; no running until months 3-4…
Sutter Health / Palo Alto Medical Foundation	WB to tolerance wk 1 → WBAT with assist wk 2 → FWB by end of wk 4; brace locked 0° wk 1	Brace locked 0° wk 1; running criteria-based (90% quad strength, single-leg squat, hop test, single-leg…
Sutter Health / Palo Alto Medical Foundation — + Meniscus…	50% PWB wks 1-2; no WB in flexion >90° through wks 6-8; FWB by wks 6-8; brace locked 0°…	50% PWB wks 1-2; no WB in flexion >90° wks 1-8; brace locked 0° wks 1-2; running criteria-based at wks 12-16…
The Steadman Clinic	WBAT on crutches with knee immobilizer from day 1; wean crutches when full WB with normal…	Knee immobilizer while sleeping 4 weeks and while walking 6 weeks; hamstring graft: avoid hamstring stretch…
UCLA Department of Orthopaedic Surgery Sports Medicine…	WBAT immediately post-op; TDWB wks 0-2, partial wks 2-4, WBAT wks 4-6; crutches + brace…	Brace locked in full extension for ambulation and sleeping wk 1; crutches + brace x6 weeks (allograft…
UCLA Department of Orthopaedic Surgery Sports Medicine…	TDWB/NWB wks 0-4 with two crutches; WBAT wks 4-6; no WB when knee flexed >90 deg wks 0-4	Brace locked extension wk 1; brace unlocked to 0-90 deg wks 2-6; crutches + brace x6 weeks; NWB/TDWB wks 0-4…
UCLA Department of Orthopaedic Surgery Sports Medicine — BTB…	NWB wks 0-2; TTWB wks 2-4 (locked brace); wean from brace at 6-8 weeks; NWB x6 weeks if…	Brace locked in full extension x4 weeks for ambulation and sleeping; NWB with two crutches wks 0-2; TTWB…
UCLA Department of Orthopaedic Surgery Sports Medicine…	PWB wks 0-1 with crutches + brace; progress to full WB by 4 weeks; wean from…	Brace locked extension wks 0-1; brace unlocked <90 deg wks 1-3; wean from brace/crutches by 4 weeks; avoid…
UCLA Department of Orthopaedic Surgery Sports Medicine…	NWB wks 0-4; WBAT at wk 4; wean from crutches/brace by 6 weeks	Brace locked extension wks 0-4 for ambulation and sleeping; NWB x1 week, NWB with locked brace + two crutches…
UCLA Department of Orthopaedic Surgery Sports Medicine…	WBAT immediately post-op; wean from crutches/brace by 4 weeks	Brace locked in extension for ambulation until full extension + good quad control; wean from crutches/brace…
University Hospitals — (BTB/Hamstring/Quad Autograft or…	50% flat-foot WB (FFWB) during week 1 (avoid WB until nerve block wears off); crutches…	Brace locked in extension week 1 then unlocked as ROM/quad control allow (goal D/C 4-6 wks); ROM as tolerated…
University Hospitals — with Meniscus Repair (incl. Meniscus…	WBAT to 50% WB x4wks, or NWB x4wks, depending on repair type per surgeon; crutches until…	Brace locked in extension x2wks then unlocked as ROM dictates (goal D/C 4-6wks); ROM limited 0-90 deg x4wks…
University of Colorado Anschutz (CU) — with Meniscus Repair	PWB wks 0-3; FWB without limp from wk 3; root repair: NWB x 4 wks, PWB wks 4-6, FWB at 6…	Brace unlockable to 90 deg, worn at night; posterior horn meniscus ROM restrictions (90 deg limit wks 2-3…
University of Delaware Physical Therapy — All Graft Types	WBAT on crutches with active quad contraction; D/C crutches when normal gait, no SLR lag…	D/C brace/immobilizer when SLR without lag and visible quad activation; allografts 12+ months return to…
University of New Mexico (UNM) Sports Medicine	Full weight bearing immediately; no brace	No brace required; criteria-based progression through 5 phases
University of New Mexico (UNM) Sports Medicine — with…	TDWB x 6 weeks for radial/root repairs; WBAT for all other meniscal repair types	0-90 degrees flexion for first 6 weeks; WB status depends on repair type (radial/root vs. other); D/C brace…
University of Virginia Orthopaedic Surgery — Multiple Graft…	WBAT with crutches; wean as tolerated; no brace needed	Hamstring autograft: delay hamstring strengthening x 12 wks, heel slides to 90 deg; BPTB: hamstring curls…
University of Virginia Orthopaedic Surgery — with Meniscus…	TTWB (25%) x 2 wks; 50% WB wks 2-6; FWB after 6 wks; D/C crutches Phase 2	Brace 0-90 deg x 6 wks (unlocked at all times after nerve block resolves); no forced flex x 6 wks; hamstring…
University Orthopedics (Brown University) — ACL Revision…	PWB in brace x 6 weeks; WBAT D/C crutches when gait is WNL (~Phase IV)	Brace locked in extension x 6 weeks (open to available range when quad control achieved); no contact sports…
University Orthopedics (Brown University) — (Criterion-Based)	WBAT with crutches as needed for optimal gait from early stage; D/C crutches when normal…	Brace discharged after first post-op visit if full active extension and SLR without lag achieved…
UW Health Sports Medicine — All Soft Tissue Graft (Adult)	PWB with crutches progressing to WBAT; FWB by Phase II (~4-6 weeks)	Extension brace 2-4 wks (locked to unlocked); bike <15 min in Phase II; no impact until Biodex <30% quad…
UW Health Sports Medicine — Hamstring Graft, No Hardware…	PWB + locked brace wks 0-2; WBAT + 1-2 crutches + locked brace wks 3-4; WBAT +/- crutches…	Longer brace/crutch use than adult; ROM 0-90 x 4 weeks; avoid aggressive hamstring sets early (donor site)…
UW Health Sports Medicine — Hamstring Graft Over-the-Top…	PWB progressing to WBAT; brace locked in extension during all WB/walking x 6 weeks	Brace locked x 6 wks for all WB; ROM 0-90 x 4 wks; avoid aggressive hamstring activities early (donor site)…
UW Health Sports Medicine — IT Band Extraphyseal (Pediatric)	TDWB wks 1-2; PWB wks 3-6; WBAT after ~7 weeks	Brace locked in extension x 6 wks; ROM 0-60 wks 1-2 and 0-90 wks 3-6 (strict — protects periosteal stitch on…
UW Health Sports Medicine — Patellar Tendon Graft (Adult)	PWB progressing to WBAT; brace unlocked for ambulation ~2 wks; FWB by Phase II	Brace locked at night x 2 wks, unlocked for ambulation early; patellar tendon donor site pain monitoring for…
UW Health Sports Medicine — Quadriceps Tendon Graft (Adult)	PWB progressing to WBAT; brace unlocked within 1 wk for ambulation; FWB by Phase II	QTG at higher risk for flexion loss and scar tissue — early mobility critical; brace unlocked within 1 wk…

ACL Reconstruction Rehabilitation Protocols

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