ACL Reconstruction — Multiple Graft Types

University of Virginia Orthopaedic Surgery

Weight-Bearing

WBAT with crutches; wean as tolerated; no brace needed

Key Restrictions

Hamstring autograft: delay hamstring strengthening x 12 wks, heel slides to 90 deg; BPTB: hamstring curls adding weight as tolerated, CKC quad strengthening OK; knee flex 0-120 as tolerated

Timeline & Phases

5 phases: Phase 1 (0-4 wks, protect graft, AROM as tolerated, WBAT with crutches), Phase 2 (4-10 wks, normal gait, full flexion, strength and proprioception), Phase 3 (10-16 wks, full ROM, about 70% strength, running toward 12 wks BTB / 16 wks hamstring), Phase 4 (4-6 months, agility, hop tests 85%, STEP and LEAP testing at 4 and 6 months), Phase 5 (6+ months, return to athletics/work)

Notes

Differentiates BPTB vs hamstring autograft in strengthening guidelines; no brace needed; no immobilizer after nerve block wears off