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ACL Reconstruction Rehabilitation

Welcome to our ACL Reconstruction Rehabilitation video series. The goal of these videos is to maximize your recovery following ACL reconstruction surgery. This video should not be used as a substitute for regular physical therapy visits and guidance from your physician.

Click here to download a pdf version of the ACL Reconstruction Rehabilitation Guide

PHASE I – EARLY MOTION AND MUSCLE REACTIVATION (0-2 weeks post-op)

GOAL:  Minimize knee stiffness and help regain muscle contraction

KEY POINTS:

  • Very important to limit pain and swelling after surgery, which can significantly limit early rehab
    • NSAIDs (i.e., Aleve, Advil), ice and elevation may help reduce pain and swelling
  • Work to achieve full extension (straightening of the knee) ASAP following surgery
  • Motion goals:
    • Full extension immediately post-op
    • Bending to 90 degrees during week 1
    • Bending to 115 degrees during week 2
  • Use crutches for 1-2 weeks until comfortable without them.
  • Use brace locked straight for walking for 3-4 weeks until strength returns; discontinue per physician or therapist approval
  • Conduct exercises 3-4 times daily in this phase
    • Start with one set of 12-15 reps
    • Progress to 2 sets of 20 reps
  • Conduct balance exercises with eyes open at first, and then closed as balance improves

PHASE 2 – BALANCE AND NORMAL GAIT (2-4 weeks post-op)

GOALS:  Improve range of motion to normal; restore normal gait pattern

KEY POINTS:

  • Continue with stretching exercises [1-6 in video] 3 times per day to increase motion
    • Motion goal = Full extension to full bending compared to the uninvolved knee by week 4 post-op
    • Start prone hangs [3 in video] with ankle weights if full extension is not yet achieved
  • Conduct light strengthening [7-17 in video], balance [19-22 in video], and core [29-33 in video] exercises daily – start with one set of 12-15 reps and progress to two sets of 20 reps
    • OK to add ankle weights for straight leg raise
  • For gait exercises [23-28 in video] start with one pass per exercise [approx. 20 ft]; increase to two passes as tolerated
  • Use light stationary bike [10-15 minutes only] once you’ve achieved enough bending of knee to clear pedal rotation
    • More than 15 minutes can cause irritation and swelling at this point

PHASE 3 – EARLY STRENGTHENING AND COORDINATION (4-6 weeks post-op)

GOALS:  Improve balance and muscle activation; progress strengthening exercises

KEY POINTS:

  • Continue all motion exercises from Phase 2 until full range of motion.
  • Conduct 1-2 sets of 20 reps for strengthening exercises; continue daily
    • If you feel that there are too many strengthening exercises early on, pick 4-5 to do and increase the number as your strength improves
    • If swelling or irritation develops, conduct exercises every other day
  • Do exercises on both legs to prevent imbalance
  • Balance exercises – progress to no touch; progress to no wall or chair assist
  • Gait exercises – continue with 1-2 passes (20ft up and back) daily
  • Stationary bike can be increased to 20-30 min as tolerated
  • Remember to ice for 10-15 minutes following exercise sessions to prevent inflammation (pain and swelling)

PHASE 4 – ADVANCED STRENGTHENING AND COORDINATION (weeks 6-12 post op)

GOAL:  Improve strength, coordination and muscle endurance as precursor to future phases

KEY POINTS:

  • Conduct exercises 3-4 times weekly; strengthening exercises: 1-2 sets of 20 reps
    • Avoid irritation – if painful back off exercise frequency or intensity
  • Ice following exercise for 10-15 minutes
  • Cardiovascular exercise – cross train to avoid irritation, do different exercises daily
    • Continue stationary bike for 20-30 minutes
    • Okay to add elliptical trainer or stair stepper
    • Okay to add light running progression around week 10 post-op – start with walk/jog intervals and progress to jogging

PHASE 5 – PLYOMETRICS AND AGILITY (month 4 post-op)

GOALS:  Continue strengthening; start plyometric and agility training in anticipation for returning to sports and functional training.

KEY POINTS:

  • Warm up for 5 minutes (over 20 yards)
  • Continue exercise 3-4 times per week; 1-2 sets of 20 reps as tolerated
  • Exercises can also be done for timed duration (ex: start 30-second period and progress to 60-seconds)
  • Ok to switch up exercises in certain groups (ex: PLYOMETRIC) – try 4-5 exercises one session and a different 4-5 exercises in the next session, etc.
  • Cross training: Include 15 – 30 minutes of jogging, elliptical, or bike at end of rehab session to improve cardiovascular endurance

PHASE 6 – ADVANCED SPORTS AND FUNCTIONAL TRAINING (months 5+ post-op)

GOAL: Prepare for return to sports and high-level activity

KEY POINTS:

  • Warm up for 5 minutes (over 20 yards)
  • Add dumbbells to increase resistance of strength exercise
  • Continue cross-training to develop cardiovascular endurance
  • Return to full sports activity based on physician approval

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