ACL Reconstruction

The Steadman Clinic · Dr. Peter J. Millett MD, MSc

Weight-Bearing

WBAT on crutches with knee immobilizer from day 1; wean crutches when full WB with normal heel-toe gait and no limp; knee brace for all walking through 6 weeks

Key Restrictions

Knee immobilizer while sleeping 4 weeks and while walking 6 weeks; hamstring graft: avoid hamstring stretch for 6 weeks, delay seated leg curls to weeks 8-10, avoid prone leg curls; no driving right knee 4-6 weeks, left knee 3-4 weeks; no mountain biking or hill climbing; return to sport no earlier than 24 weeks (6 months)

Timeline & Phases

Pre-op (quiescent knee required: full ROM, minimal swelling, normal gait); Days 1-7 (immobilizer, SLR, quad sets, passive flexion to 90°); Days 8-10 (outpatient PT, maintain extension); Week 3 (100-120° flexion, partial squats, toe raises, wean crutches); Weeks 3-4 (leg press 70-0°, stationary bike, elliptical, swimming); Weeks 4-6 (125° flexion, balance board); Weeks 6-12 (135° flexion, treadmill, outdoor biking flat); Weeks 12-20 (jogging, running, agility drills, zig-zags); 24 weeks (return to sport)

Notes

Dr. Peter J. Millett MD MSc; The Steadman Clinic, Vail, CO; return to sport at 24 weeks minimum: quad strength >= 80%, hamstring strength >= 80%, full ROM, no swelling, good stability, completed running program; GameReady cold/compression immediately post-op; pre-op priority: surgery only when knee quiescent (surgery timing is key determinant of stiffness risk); stationary bike encouraged from day 1; tilt/balance board begins weeks 4-6; functional ACL brace optional weeks 12-20

Surgeon / Author

Dr. Peter J. Millett MD, MSc