ACL — Non-Operative ACL Management

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

WBAT with crutches until normal gait mechanics demonstrated Phase I; crutches discontinued Phase II

Key Restrictions

Alert physician if episodes of knee buckling reported (all phases); avoid patellofemoral stress Phase III; caution with pivoting/lateral movements Phase III; limited/controlled lateral movements Phase IV

Timeline & Phases

Phase I, Acute Phase: control pain/swelling, restore pain-free ROM, improve flexibility, normalize gait mechanics, establish good quad activation, WBAT with crutches until normal gait, patellar mobilization, belt calf/hamstring stretch, heel slides, prone quad stretch, cycle minimal resistance 10-15 min daily, quad sets, SLR (no lag), hip abd/add/ext/ER against gravity, partial-range bodyweight squats, standing TKE with theraband/cable column, standing/prone hamstring curls, heel raises — swelling/ROM deficits must resolve before progressing; Phase II, Sub-Acute/Strengthening Phase: avoid patellofemoral pain, maintain ROM/flexibility, restore muscle strength, improve neuromuscular control, discontinue crutches, cycle/elliptical 10-15 min, open chain hip/knee strength with ankle weights, hamstring strengthening progression (standing curl to leg curl machine to ball curl to single leg deadlift), leg press (double-to-single limb), step-up progressions, BOSU/sport-specific work, planks/side planks/single-limb bridge, static single-limb balance (eyes open to closed, foam pad); Phase III, Limited Return to Activity Phase: avoid patellofemoral pain, maintain ROM/flexibility, progress single leg strengthening, progress dynamic proprioception, initiate plyometrics and light jogging, gradual return to sport pending physician clearance, avoid patellofemoral stress, caution pivoting/lateral movements, cycle/elliptical/treadmill with progressive resistance, step-up height progression, single-limb deadlift, static lunge progressions, single-limb balance with perturbations (foam, BOSU, sport-specific), plyometrics emphasizing eccentric control (avoiding trunk flexion, genu valgum, femoral IR) — simple then complex double-limb jumps, monitor swelling with plyometrics; Phase IV, Return to Activity/Sport Phase: maintain ROM/flexibility/strength, continue progressive/dynamic strengthening/proprioceptive/plyometric/agility training, achieve adequate strength for sport return pending clearance, limited/controlled lateral movements, continue cardio program with progressing intensity/duration, strengthening with increased load/decreased reps, static-to-dynamic lunges, advanced proprioceptive training, plyometrics (single-limb jumps, combination double/single-limb jumps), sport-specific drills, speed/agility program

Notes

OSMS Rehabilitation Guidelines; conservative management pathway for ACL injury without surgical reconstruction; structured around avoiding patellofemoral stress and monitoring for knee buckling episodes throughout all phases