Kerlan-Jobe Protocol

SUMMARY OF THE REHABILITATION PROGRAM FOLLOWlNG ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

FROM THE KERLAN - JOBE ORTHOPAEDIC CLINIC

DEPARTMENT OF PHYSICAL THERAPY

BY CE BREWSTER, MS PT; JL SETO MA, PT

DAY 1 - DAY 7:

a) Days 2 to 3 (hospital): Continuous use of CPM immediately post-op. Goal: 0 degrees knee extension and 90 degrees knee flexion.

b) Days 3 to 7 (home): 6 - 8 hours per day at the slowest speed (e.g. 1-2 cycles/min.).

Wall slides.
Weight bearing to tolerance with brace locked in 0 degrees extension or as prescribed by MD. If able to do 10 repetitions of straight leg raises, may ambulate weight bearing to tolerance without the extension lock or in a functional brace. Gradually progress in weight bearing status (e.g., partial weight bearing with 2 crutches to single crutch to full weight bearing). If using a drop lock brace, gradually progress to using the brace without the extension lock. If the patient is non-weight bearing or partial weight bearing, begin ankle strengthening exercises using surgical or rubber tubing.

DAY 7 - 2 WEEKS:

Hip adduction.
Quadriceps sets with support.
Hamstring sets and/or hamstring curls.
Continue use of CPM 4 - 6 hours per day. Goal: maximum available CPM flexion range of motion (ROM).
Leg press using surgical or rubber tubing for resistance. Start with the band or -tubing that gives the least amount of resistance.
Modalities to reduce pain and effusion, as needed.
Joint mobilization techniques as needed.

2 - 4 WEEKS:

Discontinue CPM at 2 - 3 weeks if able to reach and maintain the maximum available CPM range. Attempt to achieve between 120 degrees to full flexion ROM by 2 weeks post-operation.
Heel slides, if have at least 120 - 125 degrees knee flexion.
Continue hamstring curls.
Continue hip adduction.
Hip abduction, if no patellar tracking problems.
Hip extension.
Begin stationary bicycling if have 115 - 120 degrees flexion.
At 4 weeks post-surgery, perform the first monthly KT - 1000 test performed using 15 and 20 lbs. force only.
Active knee extension may be added 4 weeks post-surgery.
May add toe raises depending on patient's weight-bearing status.
Leg presses with weight resistance may be added 4 weeks post-surgery.

4 - 6 WEEKS:

May begin hip abduction, if not started secondary to patellofemoral joint complications.
May add Stairmaster, as tolerated.

1 1/2 - 2 MONTHS:

Continue lower extremity strengthening exercises with emphasis on the quadriceps, hamstrings and calf musculature.

2 - 3 MONTHS:

At 2 months, the monthly KT-1000 tests are performed using 15, 20 and 30 lbs. tests and manual max test.
Begin isokinetic strength (270/240/200 degrees per second) and endurance (300 degrees/second) training.
Progress to jogging on a trampoline.

3 - 4 MONTHS:

First monthly isokinetic strength and endurance test may be performed at 270/240/200 degrees per second and at 300 degrees/sec for endurance.
Proceed to treadmill running gradually progressing toward running for 10 - 15 minutes at a pace of 6 - 8 minutes per mile and 3 - 5% grade. Steadily advancing to outdoor running.
In addition to closed chain and isokinetic exercises, continue strengthening exercises using isotonic weight machines.

4 - 5 MONTHS:

Continue progression in running program. Begin agility drills when able to run 2 - 3 miles. Agility drills include lateral & backward running, vertical jumping, jumping rope, carioca, stair climbing, high knee drills and figure eight running.

5 - 6 MONTHS:

Begin practicing the drills of the sport, gradually progressing to full participation.