ACL Reconstruction — Hamstring Tendon Autograft

UCLA Department of Orthopaedic Surgery Sports Medicine · Thomas Kremen MD

Weight-Bearing

PWB wks 0-1 with crutches + brace; progress to full WB by 4 weeks; wean from brace/crutches by 4 weeks

Key Restrictions

Brace locked extension wks 0-1; brace unlocked <90 deg wks 1-3; wean from brace/crutches by 4 weeks; avoid hyperextension >10 degrees; flexion limited to 90 deg Phase I; caution with hamstring stretching/strengthening due to donor site morbidity; graft fixation 8-12 weeks (longer than BTB); concurrent meniscal repair/transplant: defer to that protocol; isokinetic testing at 14-16 weeks with anti-shear device; pool/unweighted treadmill running from 10-12 weeks; Phase IV requires 70% strength for agility; RTS requires 85% hop tests + 85% isokinetic strength + physician clearance; Phase V RTS at 6-7 months

Timeline & Phases

5 phases: Phase I (0-4 wks, PWB→full WB, brace locked ext wk 1 then unlocked, heel slides ≤90 deg/quad sets/SLR/aquatics, quad isometrics at 60+90 deg), Phase II (4-12 wks, wean brace 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, full WB running ~16 wks, swimming, isokinetic testing 14-16 wks, progressive hip/quad/hamstring/calf strengthening), Phase IV (4.5-7 months, agility/plyometrics — requires 70% strength + normal running gait, hop tests 85%), Phase V (6-7 months, RTS — MD clearance + sufficient ROM/strength/endurance/proprioception)

Notes

Hamstring tendon autograft — caution with hamstring stretching/strengthening due to donor site morbidity; wean from brace/crutches by 4 weeks (faster than allograft 6 weeks); graft fixation 8-12 weeks; isokinetic testing at 14-16 wks with anti-shear; concurrent meniscal repair: defer to meniscal protocol; functional brace generally not used; Phase V RTS at 6-7 months; PT 4-7 months; Thomas Kremen MD, UCLA Sports Medicine; PatientPop hosted protocol

Surgeon / Author

Thomas Kremen MD