ACL Reconstruction — ACL with Quad Tendon Autograft and Anterolateral Ligament (ALL) Reconstruction

Mammoth Orthopedic Institute / Sierra Park PT · Brian B. Gilmer MD (US Ski Team Physician); Karly M. Dawson PA-C

Weight-Bearing

TTWB with crutches x3 weeks; progressing to 50% PWB x6 weeks; DC crutches after 6 weeks when quad control returns; brace on at all times x6 weeks

Key Restrictions

TTWB x3 weeks then 50% PWB x6 weeks (more restrictive than standard ACL due to ALL reconstruction); brace locked in extension for all gait x3 weeks; no open chain resistive with weights; no downhill activity x4.5 months; earliest RTS 9 months

Timeline & Phases

5 phases: Phase I (0-3 wks, TTWB brace locked all gait), Phase II (3-6 wks, 50% PWB, advance strengthening, DC brace at 6 wks), Phase III (6 wks-3 months, neuromuscular retraining, pool, treadmill walking), Phase IV (3-5 months, running at 75%, agility), Phase V (5-8 months, plyometrics, RTS testing at 9 months)

Notes

ALL reconstruction adds TTWB x3 wks and 50% PWB restriction to x6 wks vs standard quad tendon protocol; return to sport criteria: quad/hamstring ≥90%, SL hop/vertical jump ≥90%, no effusion; earliest RTS 9 months

Surgeon / Author

Brian B. Gilmer MD (US Ski Team Physician); Karly M. Dawson PA-C