ACL Reconstruction — (BTB/Hamstring/Quad Autograft or Allograft) +/- Meniscectomy

University Hospitals · Brent Pekarski, PT; Benjamin Geletka, PT; Bradley Brigagliano, PT; Allison…

Weight-Bearing

50% flat-foot WB (FFWB) during week 1 (avoid WB until nerve block wears off); crutches used immediately post-op, weaned based on quad control/heel-to-toe pattern, goal D/C 4-6 wks

Key Restrictions

Brace locked in extension week 1 then unlocked as ROM/quad control allow (goal D/C 4-6 wks); ROM as tolerated emphasizing full passive extension; concomitant meniscectomy does not alter protocol

Timeline & Phases

Phase I (0-14d): reduce inflammation/pain, restore full passive extension, patellar mobility, quad control, independent ambulation; Phase II (2-6wks): progress to full symmetrical ROM, normalize gait, minimal effusion; Phase III (6-10wks): improve quad strength/eccentric control, reciprocal stairs, ADL endurance; Phase IV (10-16wks): continue quad strengthening, normalize flexibility/ROM, prepare return-to-run (intro running 12-16wks per criteria); Phase V (16-24wks): symptom-free running, low-to-high plyometrics, agility/change of direction; Phase VI (6+ months): sport-specific drills, RTS testing, MD clearance

Notes

One PDF covers multiple ACL procedure variants with distinct precautions (see Surgery Type) sharing a common phase-based rehab framework; includes Alter-G phased return-to-run (Appendix A), phased running progression (Appendix B), return-to-sprinting progression (Appendix C), and ACL-RSI return-to-sport testing battery (Appendix D: IKDC, Y-balance, hop testing, side hop, T-agility, LESS, isokinetic/HHD strength); BFR and NMES used throughout; quad strength LSI thresholds progress 60% (Phase III) to 85%+ (Phase VI/discharge); isokinetic dynamometer required at 3, 6 and 9 months

Surgeon / Author

Brent Pekarski, PT; Benjamin Geletka, PT; Bradley Brigagliano, PT; Allison Toole, PT (reviewed 2025 by Kayley Mitchell, PT, Lauren Bertagnolli, PT; physician sign-off: James Voos, MD, Jacob Calcei, MD, Allison Gilmore, MD, Shana Miskovsky, MD)

Published

2025