ACL Reconstruction — Isolated (No Meniscal Repair)

SOMOS (Society of Military Orthopaedic Surgeons) · Tri-Service Orthopedics & Physical Therapy Consultants

Weight-Bearing

WBAT; brace locked 0° for WB activity until 20 SLRs without extension lag; D/C crutches when quad control and gait normalized

Key Restrictions

Brace locked 0° for WB until 20 SLRs without lag; no OKC strengthening; no running until months 3-4 (criteria: pain-free hopping + ≥90% SL squats to ≥60°); RTS 9 months (90% contralateral hop test battery); no submersion 4 weeks; note: ROM limited first 6 weeks if combined with meniscal repair

Timeline & Phases

Phase 1 (wks 0-2): WBAT, brace locked 0° for WB until 20 SLRs without lag — calf pumps, heel slides, quad sets, prone hangs, HS stretching, UBE; days 8-14: patellar mobs, bike ROM, mini squats 0-45°, multi-angle hip/thigh isometrics, gait training; Phase 2 (wks 2-6): brace per Ortho — bike/elliptical/rower, pool (sagittal plane), LE stretching, progressive strengthening (quad emphasis, hip ext/abd/add, PF, core), neuromuscular training (foam pad, SL exercises, reduced visual input); Phase 3 (wks 6-12): no running — continue cardio, pool progressive, progressive strengthening, DL plyometrics (shuttle jumps, jump rope) → SL, progressive neuromuscular training; Phase 4 (months 3-6): jogging when criteria met (pain-free hopping + ≥90% SL squats to ≥60°, 10-20%/wk, Alter-G if available), agility/plyometrics (SL anterior/lateral jumps, box jumps), Biodex isokinetic testing, hop test battery, Y-balance, FMS/LESS assessment; Phase 5 RTS (9 months): sport-specific training, agility/plyometrics, RTS criteria (90% contralateral hop tests, confidence cutting/jumping at speed); pass fitness test 9-12 months

Notes

Tri-Service guidelines (Army/Navy/Air Force); published May 2020; 5-phase protocol; prehab recommendation: ≥80% quad/HS strength before surgery; ROM would be limited first 6 wks if combined with meniscal repair; RTS aggressive military training 9-12 months

Surgeon / Author

Tri-Service Orthopedics & Physical Therapy Consultants

Published

2020