ACL Conservative Rehabilitation Protocol (Shelbourne & Nitz, 1990)
 

Time After Reconstruction	Rehabilitation Program
Day 1	Leg splinted at 10° of flexion, continuous passive motion (CPM) begun.
2 - 3 Days	Ab/adduction straight leg raises (SLR), extension SLR, passive range of motion (ROM) 0° - 90°, gluteal sets, ambulation (non-weight-bearing), crutches.
5 - 6 Days	Discharge form hospital, CPM and exercise continued at home, rigid knee immobilizer (set at 10°) used except during passive knee ROM exercises, hamstring curls, ab/adduction and extension SLR, toe touch weight-bearing.
3 Weeks	Quad extensions, active ROM 60° - 90°, gradual light resistance. Note: patients should have attained passive ROM of 0° - 90° assisted by CPM or the well leg. Continue Dobi splint when up. May discontinue for sleep.
6 Weeks	Passive ROM 0° - 100°, weight-bearing as tolerated, wear IKO (functional knee brace) 10° stops, full time when walking.
8 - 10 Weeks	Full weight-bearing as tolerated, active ROM 0° - 110°, passive stretching to increase ROM, SLR with increased weights, eccentric knee extensions, short arc knee extension 90° - 45°, hamstring curls, swimming, stationary bike when patient is able to walk without crutches. Note: if patient has not attained full extension, regimen includes lying prone with 1 pound weight on ankle. Sample exercises.
12 - 14 Weeks	ROM 0° - 120°, full weight-bearing, previously described exercises continued, knee bends, step-ups (well leg first: step down, operated leg first), calf raises.
4 Months	ROM 0° - 130° (goal), brace discontinues for activities of daily living (ADL) if quad tone is good, exercises increases in intensity with higher weights and more sets and reps, fast speed isokinetics.
5 Months	Jumping Rope.
6 Months	Cybex test at 180 and 240 degrees/second with 20° block, KT-1000, lateral shuffles, walking up to 2 miles per day, short arc knee extensions to full knee extensions, squats, use of brace for activity other than ADL.
7 - 8 Months	Cybex test, KT-1000, walking, progressive running and jogging, weight lifting continued to strengthen quads, hams, and calf muscles, jogging followed by progressive running program, including backward running and hill running, agility drills including large (gentle) figure eights, lateral shuffles, slow and fast speed isokinetic strengthening exercises.
9 - 12 Months	Return to normal activity levels if strength is greater than 80% of the non-operated knee, full ROM, no pain or swelling, successful completion of functional progression.