ACL Reconstruction — Pediatric

Massachusetts General Hospital · MGH Brigham Pediatric Sports Medicine

Weight-Bearing

WBAT with brace locked and crutches initially; allograft/hamstring autograft: PWB x 6 wks

Key Restrictions

Brace locked initially; unlock brace once SLR without lag; DC brace at 6 wks per MD; allograft/hamstring: PWB x 6 wks; no pivoting surgical side; physeal-sparing/partial epiphyseal/transphyseal surgical techniques may alter timelines (confirm with surgeon); depth jumps progress with caution (open epiphyseal plates); follow more conservative protocol with concomitant injuries (e.g. meniscus repair); Pedi-IKDC preferred over KOOS

Timeline & Phases

Phase I (0-2 wks): protect graft, swelling control, patellar mobs (emphasized for BPTB), NMES 2500 Hz, quad sets, SLR, multi-angle isometrics; Phase II (3-5 wks): stationary bike, partial squats 0-60 deg, balance/proprioception; Phase III (6-8 wks): elliptical/pool, gym equipment, hamstring autograft: resisted HS at 12 wks; Phase IV (9-12 wks): sub-max sport-specific sagittal plane, bilateral plyometrics; Phase V (3-5 mo): return-to-run program, agility/plyometrics; Phase VI (6+ mo): multi-plane cutting/pivoting ~7 mo, full play ~9 mo

Notes

Revised 04/2024; 6-phase criterion-based protocol; Phase V criteria: quad/HS/glut >=90%, H:Q >=66%, hop >=90%; Phase VI criteria: >=95% all, Pedi-IKDC improvement; NMES 2500 Hz 75 bursts used; biological age/training age/epiphyseal plate/psychological state considerations detailed; machine sizing guidance for adolescents. [Archived copy — original Massachusetts General Hospital URL retired in the Mass General Brigham site migration; Wayback snapshot 2025-02-16.]

Surgeon / Author

MGH Brigham Pediatric Sports Medicine

Published

2024-04