9-Anterior cruciate ligament repair, Post-Operative Physical Therapy Protocol

General Considerations:

-Passive and active range of motion between 30 - 70 degrees for 4 weeks. -Patient will be instructed to come out of the brace once a day for extension range of motion stretching beginning week 2.
-Crutch assisted weight bearing progressing to full as tolerated.
-Regular attention should be paid to the incisions to decrease fibrosis and scarring--with particular emphasis on the anterior and lateral incisions.
-Exercises and manual treatments should also focus on early quadriceps and VMO recruitment.
-Patients are given a functional assessment/sport test at 2, 3, and 4 months post-op
Week 1:
-M.D. visit day 1 to change dressing and review home program.
-Icing and elevation as much as able.
-Straight leg raise exercises (lying, seated, and standing), quadriceps/adduction/gluteal sets, gait training, passive and active range of motion exercises within guidelines.
-Balance and proprioception exercises.
-Soft tissue treatments and gentle mobilization to posterior musculature, patella and incisions.
Weeks 2 - 4:
-M.D. visit at 8 - 10 days.
-Incorporate functional exercises (i.e. squats/knee bends, modified lunges, step-ups).
-Instruct on once a day, passive extension stretching.
-Continue with pain control, range of motion, gait training, soft tissue treatments and balance & proprioception exercises.
-Pool workouts after the incisions are healed and with the use of the brace.
-Aerobic exercises as ROM allows (i.e. VersaClimber, stair machine, UBE, NordicTrac).
Weeks 4 - 6:
-M.D. visit at 4 weeks, will discontinue use of post-op brace at that time (may wean off brace with full range of motion if significant weakness or apprehension).
-Push for full range of motion with emphasis on extension.
-Increase intensity of all exercises with focus on closed-chain, functional progression.
-Stationary and road cycling as tolerated.
Weeks 6 - 8:
-Continue to increase the intensity of exercises (i.e. stretch cord resistance, adding weight, increasing resistance of aerobic machines).
-Add lateral training exercises.
-Begin to incorporate sport- or activity specific training.
Weeks 8 - 15:
-Progression of program of increasing intensity to return to sports and activities of daily living.
-Incorporate bilateral jumping exercises once able to demonstrate adequate strength. Watch for compensatory patterns with take-offs or landings.
Weeks 12-20:
-Patients are not scheduled for another M.D. appointment until 3 - 4 months post-op.
- At this point, range of motion should be at or near 100 % and any restrictions or concerns should be communicated to our office.