ACL Reconstruction — BTB Autograft with Osteochondral Allograft

UCLA Department of Orthopaedic Surgery Sports Medicine · Thomas Kremen MD

Weight-Bearing

NWB wks 0-2; TTWB wks 2-4 (locked brace); wean from brace at 6-8 weeks; NWB x6 weeks if radial meniscus/root repair

Key Restrictions

Brace locked in full extension x4 weeks for ambulation and sleeping; NWB with two crutches wks 0-2; TTWB locked brace wks 2-4; wean from brace at 6-8 weeks; if radial meniscus tear repair or meniscus root repair: NWB x6 weeks; CPM if concurrent cartilage procedure (4 weeks at 8 hrs/day: 0-45 deg wk 1, 0-60 deg wk 2, 0-75 deg wk 3, 0-90 deg wk 4); flexion limited to 60 deg x3 weeks then 90 deg only by wk 4; avoid hyperextension >10 degrees; quad strengthening caution — donor site morbidity (tendinitis risk); avoid squatting and hurdler's stretch Phase III; revision surgery: add ~2 weeks to timeframes; RTS requires 85% hop tests + 85% isokinetic strength + MD clearance

Timeline & Phases

5 phases: Phase I (0-4 wks, NWB→TTWB locked brace, CPM if cartilage procedure, flexion ≤60 deg x3 wks then ≤90 deg by wk 4, heel slides/quad sets/SLR/aquatics), Phase II (5-12 wks, wean from brace, CKC — wall sits/step-ups/mini-squats/leg press/lunges, Stairmaster/elliptical/biking, proprioception, pool/unweighted treadmill at 10-12 wks), Phase III (12-20 wks, full ROM, OKC leg extension 90-30/eccentrics, full WB running ~16 wks, swimming, isokinetics — 70% strength goal), Phase IV (4.5-7 months, agility/plyometrics — requires 70% strength + normal running gait, hop tests 85%), Phase V (6-7 months, RTS — requires MD clearance + sufficient ROM/strength/endurance/proprioception)

Notes

Combined BTB autograft + osteochondral allograft (cartilage procedure); CPM prescribed if cartilage procedure — 8 hrs/day x4 weeks with progressive ROM; avoid squatting and hurdler's stretch Phase III; donor site morbidity caution for quad strengthening; revision surgery: add ~2 weeks; NWB x6 weeks if radial meniscus/root repair; identical content also hosted at sa1s3optim.patientpop.com/assets/docs/441716.pdf; PT 4-7 months; Thomas Kremen MD, UCLA Sports Medicine

Surgeon / Author

Thomas Kremen MD