ACL Reconstruction — Patellar Tendon (BTB) Autograft

UCLA Department of Orthopaedic Surgery Sports Medicine · Thomas Kremen MD

Weight-Bearing

WBAT immediately post-op; wean from crutches/brace by 4 weeks

Key Restrictions

Brace locked in extension for ambulation until full extension + good quad control; wean from crutches/brace by 4 weeks; avoid hyperextension >5 degrees; no OKC hamstring work if concurrent meniscal repair/transplant; no breaststroke swimming; isokinetic testing at 12 weeks with anti-shear device recommended; revision ACL: slower progression, goal RTS at 1 year; Phase IV requires 70% strength; RTS requires quad/hamstring 85% uninvolved + single hop 85% uninvolved + physician clearance

Timeline & Phases

5 phases: Phase I (0-4 wks, WBAT, brace locked until good quad control, quad sets/SLR/heel slides/NMES/CKC/single leg balance/stationary bike, AAROM), Phase II (4-10 wks, wean crutches/brace if needed, CKC progression — one-leg squats/lunges/step-ups/Stairmaster/elliptical/Nordic Trac, pool/unweighted treadmill running from 8 wks), Phase III (10-16 wks, full ROM, knee ext 90-30/isokinetics with anti-shear, full WB running at 12 wks, swimming), Phase IV (4-7 months, agility/plyometrics — requires 70% strength + normal running gait + no PF irritation, hop tests 85%), Phase V (8-9 months, RTS — requires 85% quad/hamstring strength + 85% hop test + MD clearance)

Notes

BTB autograft — faster revascularization; wean from brace/crutches by 4 weeks (vs 6 weeks for allograft); avoid hyperextension >5 deg (stricter than hamstring protocol 10 deg limit); isokinetic test at 12 wks with anti-shear device; revision ACL: slower progression, RTS goal 1 year; Phase IV hop tests: single hop + 3-hop at 85% uninvolved; functional brace generally not used but may be recommended individually; Thomas Kremen MD, UCLA Sports Medicine; PatientPop hosted protocol

Surgeon / Author

Thomas Kremen MD