ACL Reconstruction

Gundersen Health System (GLSM) · Gundersen Health System Sports Medicine

Weight-Bearing

WBAT with brace locked in extension wk 0-1; WBAT with brace unlocked wks 1-4 if good quad control and full extension; D/C crutches with normal heel-toe gait; D/C brace wk 4

Key Restrictions

Brace 0-90 deg wks 0-1, 0-120 deg wks 1+ (not all patients use a brace); ROM 0-90 wks 0-2, 0-110 wks 2-3, 0-120 wks 3-4, full by wk 6-8; hamstring autograft: no isolated resisted knee flexion initially, graded isometrics wk 4, isotonics wk 6; avoid twisting/pivoting x 6-8 wks, quick twisting/pivoting x 10-12 wks; avoid reciprocal stair descent until adequate quad control; with meniscus repair, follow meniscus WB restrictions, ROM 0-90 x 2 wks, no squatting >90 deg x 4 months

Timeline & Phases

4 phases: Phase I (0-6 wks, maximum protection, early NMES and OKC knee extension), Phase II (6-12 wks, moderate protection, full ROM, foot placement drills wk 9, isokinetics wk 8-10), Phase III (12-24 wks, advanced strengthening, return to running at 4 months, landing and agility drills at 4-5 months), Phase IV (6-9 months, return to higher level activity, sport-specific drills); return to sport 9-12 months

Notes

Evidence-based; covers patellar tendon, hamstring/gracilis and allograft; early NMES strongly recommended (ideally 3x5 in pads); early isolated OKC knee extension per tolerance; optional BFR; criterion-based return-to-running and return-to-sport testing algorithm (Biodex limb symmetry 75% to run, 90% for sport; Y balance <4 cm; hop tests; ACL-RSI for fear avoidance); 6-step return-to-sport progression over 2-4 wks; IKDC tracked at 6M, 9M, 1Y, 2Y, 5Y

Surgeon / Author

Gundersen Health System Sports Medicine

Published

Updated November 2023