ACL Reconstruction

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

Toe-touch WB in locked brace at 0 deg Phase I (brace worn 3 wks locked in extension while ambulating/sleeping); crutches discontinued Phase II if no quad lag with SLR, no quad inhibition, and 60 sec squat hold with band

Key Restrictions

No ligament stability testing (Lachman, A/P drawer, varus/valgus stress) before 12 wks; avoid isotonic resisted hamstring exercises x8 wks with hamstring autograft; open chain knee extension and isokinetic strengthening not until after 8 wks; AAROM limited to 100-0 deg Phase I

Timeline & Phases

8 phases: Phase I (0-2 wks): TTWB in locked brace at 0 deg (worn 3 wks for ambulation/sleeping), reduce swelling with cryocuff, AAROM 100-0 deg, heel slides, seated/passive prone flexion stretch, prone hangs, patellar mobs, ankle pumps, quad sets, flexion SLR with ankle weight, passive extension stretch, clamshells, abd SLR, standing TKE into band, standing knee flexion, NMES to quads with quad set/SLR, bike; Phase II (2-4 wks): achieve symmetric full motion, minimize swelling with standing activities, discontinue crutches per criteria, LE/hip flexibility, hydrants, flexion/abd SLR with ankle weights, NMES, mini squats, squat holds, heel raises, bridge holds, hamstring curl on ball, planks, supermans; Phase III (4-6 wks): balance/stability focus, incline walking, multi-directional wobble board, single leg balance, 8in step-ups, standing hydrant holds, single leg bridge/hamstring curl on ball, front/side plank variations, bike/Stairmaster/Aquacisor/retrograde treadmill; Phase IV (6-11 wks): non-impact strengthening 6-day/week program, continues Phase III exercise set with progression; Phase V (12-16 wks): non-impact strengthening 6-day/week (3 cardio/3 strength), adds single leg squats, step-downs (goal 8in), 12-18in power step-ups, single leg RDLs; Phase VI (16-20 wks): return to jumping 6-day/week (3 cardio/3 strength-plyometrics), plyometric/jump rope progression (stationary jump, jump over line, drop jump to 18in, hurdle jump); Phase VII (20-24 wks): return to running 6-day/week, jogging progression at 60-70% to continuous running, plyometrics (10-yard broad jump, single leg hop for distance, hurdle hop, bounds); Phase VIII (24+ wks): cutting and change of direction 6-day/week, lateral shuffle, deceleration, 90 deg cuts, 18in box jump, triple hop, lateral shuffle/deceleration/cutting validation required

Notes

OSMS Rehabilitation Guidelines; criterion-based progression requiring documented flow sheets for MD visits at multiple phases; references Adams/Logerstedt/Snyder-Mackler (JOSPT 2012), Manal/Hoffman/Sturgill ISC 21.2.11, Myer/Paterno/Hewett (JOSPT 2006), Noyes Knee Institute, UW-Madison, and Wilk/Andrews (JOSPT 2012) ACL protocols