ACL Reconstruction — with MCL Reconstruction

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

NWB with locked brace in extension Phase I (2 wks); TWB to 50% WB with crutches Phase II, brace remains locked; crutches discontinued Phase III when gait non-antalgic, brace unlocked while out of house until wk 12

Key Restrictions

Brace locked for ambulation/sleeping Phase I; ROM 0-90 deg Phase I with emphasis on full extension and passive flexion only; active knee extension from 40 deg only starting Phase II; avoid valgus moments throughout to protect repaired MCL; brace may D/C at 8 wks in safe environment but remains unlocked outside home until wk 12; return to sport surgeon-directed after 22 wks

Timeline & Phases

Phase I (0-2 wks): NWB with locked brace in extension (worn for ambulation/sleeping), reduce swelling with cryocuff, ROM 0-90 deg emphasizing full extension with passive flexion only, patellar mobilization 5-10 min/day, SLR in locked brace (3x10, 3x/day), quad sets, ankle pumps; Phase II (2-6 wks): TWB to 50% WB with crutches, brace remains locked at 0, ROM 0-125 deg maintaining full extension, active knee extension exercises from 40 deg, UE ergometry, core strengthening; Phase III (6-14 wks): discontinue crutches when gait non-antalgic, dual-to-single limb control, brace D/C at 8 wks in safe environment (unlocked outside home until wk 12), avoid valgus moments, AAROM advancing to quad stretching/proprioception (perturbations) at wk 12, wks 6-10 hamstring strengthening/progressive mini-squats/weight shifts/proprioceptive training/step-up program/standard ergometry, wks 10-14 step-down program/leg presses/lunges/isotonic knee extensions (90-40 deg, closed chain preferred)/retrograde treadmill, Aquacisor/retrograde treadmill cardio; Phase IV (14+ wks): agility exercises (sport cord), forward running program once 8in step-down satisfactory, continue LE strengthening/flexibility/proprioceptive/agility programs, initiate agility drills and cutting activities, initiate plyometric program, advance agility/sport-specific programming, return to sport surgeon-directed after 22 wks, maintenance exercise program

Notes

OSMS Rehabilitation Guidelines; combined ACL/MCL reconstruction protocol distinct from OSMS's standalone ACL Reconstruction protocol — more conservative WB progression (NWB then TWB to 50% vs. TTWB from day one) and longer brace/valgus protection timeline to protect the repaired MCL