University of Oregon Athletic Medicine Anterior
Cruciate Ligament Rehabilitation Protocol
Purpose: The purpose of having a written protocol for the rehabilitation
of knees after ACL reconstructive surgery is not to create a "cook
book" formula, but to have an outline that can be followed as a consistent
guideline for progression of the athlete. The time frames may change depending
on the goals of each athlete and the philosophy of the surgeon. Ideally,
surgery would be delayed until knee motion and quadriceps control are restored
and effusion is minimal.
Weeks 1-4
Goals:
- Decrease pain and swelling
- Increase ROM
- Progress from partial to full weight bearing with proper gait
- Increase quadriceps and hamstring strength
- Promote proper patellofemoral function
- Initiate restoration of proprioception
- Promote crossover effect by exercising uninvolved knee
Specific Rehabilitation Techniques:
- Ice/electrical modalities
- Quadriceps/hamstring sets (single & co-contraction)
- Biodex PROM (Pain-Free)
- Patellar mobilization
- Prone hangs (Progress to ankle weights)
- Supine passive terminal extension stretch
- VMO training (starting w/QS & Russian EMS)
- Lateral complex stretching & McConnell taping (If necessary)
- Ankle pumps & PNF
- AROM leg extension (No resistance)
- MRE for hip (Ext., ab., ad., flex. (bent knee)) Note: Adduction is
contraindicated during this time for athletes who also injured their MCL
- Non-weight bearing to weight bearing step-up progression
- Bike for ROM
- ¼ Squats
- Carpet Drags
- Step-ups w/Russian EMS
- Shuttle w/Russian EMS
- Sport cord 1/3 squats (double & single leg)
- Shuttle leg presses (double and single leg)
- Leg curls (single)
- Bridging with and without a physioball (Can be initiated after athlete
has 45 degrees of flexion)
- Single leg balance (Begin on floor, progress to foam and then to trampoline)
- UBE
- Calf exercises (Seated machine, leg press, shuttle, standing)
Weeks 5-12
Goals:
- Continue to strengthen the quadriceps muscles with closed chain exercises
ONLY
- Continue to strengthen the hamstring muscles
- Facilitate proper gait patterns and joint mechanics
- Continue to facilitate proprioception
- Initiate restoration of cardiorespiratory function
Specific Rehabilitation Techniques:
- WWP (AROM)
- Leg curls (single)
- Hip & thigh machine
- Step-downs w/Russian EMS
- Backward walking on treadmill (Progress to 2.0 MPH at 12x % grade for
5 minutes)
- Shuttle leg presses (Double & single leg)
- Leg press
- Tubing squats
- Biodex (Hamstrings only)
- Eccentric hamstrings on Biodex
- Squats (Back & overhead)
- Pool
- Bike
- Form walking routine
- Balance squats
- Single leg balance (Progress to trampoline: eyes open/closed w/wo body
blade)
- Stairmaster
- Slideboard
- Treadmill walking
- Treadmill walk/jog
- Treadmill jogging
- Treadmill walking/running
- Seated calf raises
- Ball toss
- Chair scoots
- Calf exercises (seated machine, leg press, shuttle, standing)
Weeks 13-24
Goals:
- Continue increasing strength, power, muscular endurance
- Restoration of cardiorespiratory function
- Further development of normal gait patterns
- Progress from general sport movements to sport and position specific
drills
Specific Rehabilitation Techniques:
- Stairmaster
- Bike
- Treadmill Jogging
- Leg curls (Single)
- Biodex (Hamstrings only)
- Eccentric hamstrings on Biodex
- Ball toss (Foam & trampoline)
- Strides
- Figure 8’s
- Zig-zags
- Stadiums
- Form walking/running routine
- Slideboard
- Sport cord jogging
- Leg press
- Shuttle leg presses (Double & single leg)
- Shuttle jumps (Double & single leg)
- Fitter
- Calf exercises (Seated machine, leg press, shuttle, standing)
6-9 Months
Goals:
- Increase strength, power, muscular endurance to 90%+ of uninvolved
leg
- Increase running and cutting to meet demands of individual sport
- Increase cardiorespiratory function to levels needed for particular
sport participation
- Progress to partial of full sport activities
Specific Rehabilitation Techniques:
- Biodex testing (180 degrees – 10 reps, 300 degrees – 15 reps)
- Return to activity drills
- Agilities
- Plyometric program
- Calf exercises
- Squats
- Shuttle jumps (Double & single leg)
- Leg curls (Double)
- Sprint Progression
- Integrate into normal lifting and conditioning activities with appropriate
limitations
9-12 Months
Goals:
- Continue rehabilitation of any deficient areas of involved extremity
(i.e. strength, power, muscular endurance, or cardiorespiratory function)
- Maintenance program for non-deficient areas
Specific Rehabilitation Techniques:
- Appropriate exercises from previous techniques
- Biodex Testing (If necessary)
Updated 12/96 (KOS)