Immediate Postoperative Phase (1-4 Days):
Precautions- Wait until your first physical therapy session for the therapist to change the surgical dressing for you.
- Perform sponge baths or shower with saran wrap covering surgical site.
- Avoid resisted knee extension to protect graft.
- If you experience malaise, fever, or chills- contact your physician immediately.
- Perform home exercise program issued at pre-op from Hamilton Orthopedics Physical Therapy Department.
- Control acute inflammation with the use of Cryocuff, 15-20 minutes hourly, rest, elevation, and prescribed medications.
- Ambulation: weight bearing as tolerated with the use of bilateral crutches or walker, a post-operative brace on involved lower extremity locked in full extension for 1 day. Unlock brace the day after surgery.
- If a meniscus repair was involved, restrict weight bearing to 25% for 4 weeks. At 4 weeks, full weight bearing as tolerated.
- Primary goal is to achieve terminal knee extension and good quad control.
Acute Phase (5 days - 2 weeks):
- Begin Physical Therapy 5 days postoperatively for 3 sessions per week.
- Continue to ambulate with post-op brace, needs to be worn for all weight bearing activity for 6 weeks.
- Continue to avoid resisted knee extension.
- Steri–strips should remain intact for approximately 2 weeks post–op.
- Ambulation/Gait training: begin with stance shifts to regain good quad control and advance to single crutch, then no assistive device by 2 weeks.
- Patella mobilization.
- Ankle pumps.
- Isometric quad sets.
- Active and passive terminal knee extension.
- Straight leg raises, adding resistance as tolerated (hip flexion, abduction, and extension.)
- Flexibility of hamstring, gastroc-soleus, quadriceps, hip abductors.
- AAROM: wall-slides, heel-slides, and knee flexion in chair.
- Standing calf lifts.
- Partial wall squats(<45 degrees of flexion)
- Closed chain resisted terminal knee extension (i.e ball squeeze at wall)
- AROM knee flexion.
Acute Phase Continued (14 days-4 weeks)
- Continue to progress above exercises.
- Range of motion: 0-120 degrees.
- Resisted knee flexion.
- Continue patella mobilization as needed.
- Proprioceptive and single leg balance activities (if able to fully weight bear through involved lower extremity)
- Stationary lunge.
- Partial wall squats (<60 degrees of flexion)
- Stationary bike (when able to achieve 110 degrees of flexion)
- Leg press (0-90 degrees)
- Sub maximal quad and hamstring isometrics at 45 degrees of knee flexion.
- Stairmaster, Nordic Track.
- Forward/ lateral step-ups (4-8 inches)
- Continue to control edema and discomfort.
Subacute Phase (4-11 WEEKS)
- Continue to progress above exercises.
- Begin resisted knee extension from 90-40 degrees with care not to irritate the graft site.
- Begin squats (machine based only, NO free weight squats x 6 mos.)
- Begin eccentric quad strengthening.
- Range of motion: 0-135 degrees/full.
- Emphasize closed kinetic chain therapeutic exercise.
- Walking lunges at 6 weeks post op.
- Aerobic stepping (Reebok step program) forward and lateral at 6 weeks post op.
- Fitting for sports specific functional ACL brace at Hamilton Orthopaedics at 6 weeks. Discontinue postoperative brace at that time.
Return to Activity Phase (12-15 Weeks)
- Continue to progress above exercises with emphasis on single leg strengthening for all resistive strengthening
- Perform 12 week functional test with forms provided by Hamilton Orthopaedics. Fax results to Surgeon, (315) 824-8961.
- If patient successfully completes the test, they may begin interval jogging, uniplanar double leg plyometrics, and dynamic flexibility program.
- All plyometrics and jogging should be performed with the functional ACL brace on.
Activities Progression Phase (16-19 Weeks):
- Continue to progress above exercises.
- Perform 16 week functional test with forms provided by Hamilton Orthopaedics. Fax results to Surgeon, (315) 824-8961.
- If patient successfully completes the test, they may begin single leg uniplanar, double leg multiplanar plyometrics, and agility work.
- Continue jogging program, progressing to tolerance.
- Begin sport specific training as indicated.
- All plyometrics, jogging, and sports specific training should be performed with the functional ACL brace on.
Pre-Return to Prior Level of Recreational Activities (4-9 Months):
- Continue to progress resistive and endurance exercises.
- Perform 20 week functional test with forms provided by Hamilton Orthopaedics. Fax results to Surgeon, (315) 824-8961.
- Prior to discharge, perform sports related drills implementing directional changes and sprinting.
- Discharge formal PT and continue gym program to progress strength, jogging, plyometrics, and sports related drills.
- Return to sports when released by physician at 9 months post-op.
