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.
  • Avoid active knee flexion and hip extension until 4 weeks post-op.
  • Avoid resisted knee flexion and hip extension until 6 weeks post-op.
  • 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.
  • Continue to avoid active and resisted knee flexion and hip 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).
  • Flexibility of hamstring (gentle), gastroc-soleus, quadriceps, hip adductors.
  • 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).

Acute Phase Continued (14 days - 4 weeks)

  • Continue to progress above exercises.
  • Range of motion: 0-120 degrees.
  • 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 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 active knee flexion and prone hip extension at 4 week post-op.
  • Begin resisted knee flexion and hip extension at 6 weeks post-op.
  • 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 post-operative 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 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 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.

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