Immediate Post-Operative Phase (1-4 Days):

Precautions:
  • DO NOT remove steri-strips.
  • Change surgical dressing 2-3 days postoperatively and replace with 4x4 gauze if drainage is present. (If you are a patient of Dr. Meeks, wait until your first physical therapy session for the therapist to change the dressing for you).
  • Perform sponge baths or shower with saran wrap covering surgical site. (If you are a patient of Dr. Meeks, sponge baths only. No showers until follow up with him at 1 week after surgery)
  • 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 postoperative brace on involved lower extremity.
  • 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).
  • Flexibility of hamstring, 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).
  • Active Knee extension 90-40 degrees.

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 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 (4-7 weeks):

  • Continue to progress above exercises.
  • At 4 weeks begin active range of motion knee flexion and hip extension.
  • Begin resisted knee extension from 90-40 degrees.
  • 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.
  • At 6 weeks post-operatively begin resisted knee flexion and hip extension.
  • 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 (8-11 weeks):

  • Continue to progress above exercises with emphasis on single leg strengthening for all resistive strengthening.
  • Perform 8 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, double-leg agility work, and dynamic flexibility programming.
  • All plyometrics, jogging, and agility should be performed with the functional ACL brace on.

Activities Progression Phase (12-15 weeks):

  • Continue to progress above exercises.
  • 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 single leg uniplanar and double leg multiplanar plyometrics, and progress ladder work accordingly.
  • 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.

Return to Prior Level of Recreational Activities (16-20 weeks):

  • Continue to progress resistive and endurance exercises.
  • Perform 16 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.
  • Return to sports when released by physician.

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