ACL Reconstruction — Hamstring Tendon Autograft with Meniscus Repair

UCLA Department of Orthopaedic Surgery Sports Medicine · Thomas Kremen MD

Weight-Bearing

NWB wks 0-4; WBAT at wk 4; wean from crutches/brace by 6 weeks

Key Restrictions

Brace locked extension wks 0-4 for ambulation and sleeping; NWB x1 week, NWB with locked brace + two crutches wks 1-4; WBAT at wk 4; wean from crutches/brace by 6 weeks (vs 4 weeks for hamstring-only); avoid hyperextension >10 degrees; flexion limited to 90 deg Phase I; caution with hamstring stretching/strengthening (donor site); isokinetic testing at 14-16 weeks with anti-shear device; pool/unweighted treadmill running from 10-12 weeks; Phase V RTS at 8-9 months (vs 6-7 months for hamstring-only); RTS requires 85% hop tests + 85% isokinetic strength + physician clearance

Timeline & Phases

5 phases: Phase I (0-4 wks, NWB wks 0-4, brace locked ext x4 wks, heel slides ≤90 deg/quad sets/SLR/aquatics, quad isometrics), Phase II (5-12 wks, wean brace/crutches if needed, CKC — wall sits/step-ups/mini-squats/leg press/lunges, Stairmaster/Nordic Trac/elliptical/biking, proprioception, pool/unweighted treadmill at 10-12 wks), Phase III (12-20 wks, full ROM, OKC leg extension 90-30/isokinetics with anti-shear, full WB running ~16 wks, swimming, isokinetic test 14-16 wks), Phase IV (4.5-7 months, agility/plyometrics — 70% strength + normal gait, hop tests 85%), Phase V (8-9 months, RTS — MD clearance + sufficient ROM/strength/endurance/proprioception)

Notes

Hamstring + meniscal repair variant; NWB extended to wks 0-4 (vs PWB wk 0-1 for hamstring-only); brace locked extension x4 weeks (vs x1 week); wean from brace/crutches by 6 weeks (vs 4 weeks); Phase II begins at 5 weeks (vs 4 weeks); Phase V RTS at 8-9 months (vs 6-7 months); OKC leg extension included Phase III; PT 7-12 months (vs 4-7 months hamstring-only); isokinetic testing 14-16 wks with anti-shear; Thomas Kremen MD, UCLA Sports Medicine; PatientPop hosted protocol

Surgeon / Author

Thomas Kremen MD