Multi-Ligament Knee Reconstruction — ACL Reconstruction with Multi-Ligament Reconstruction

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

Weight-Bearing

Not specified independently in source; follows precautions of the most restrictive concomitant ligament repair per surgeon

Key Restrictions

Brace discontinuation criteria: ROM 0-120 deg, normal gait pattern, no quad lag with SLR, reciprocal stair negotiation, 5 reps step-up/step-down to 7in step

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