May weight-bear as tolerated with one crutch for three weeks. ACL brace protocol the same. May do active ROM exercises as tolerated. No strengthening exercises with the knee in greater than 90° of flexion for six weeks. The patient may, however, ride the bike and go past 90° prior to this time. No squats greater than 90° for the first six weeks.

Post-op Week 1

The goals of the first week are to work towards full passive extension, begin gentle active flexion, good patellar mobility, and demonstrate control of the surgical leg. The Knee Polar Care Cryotherapy System is used extensively. Crutch walking (heel/toe) is PWB-> WBAT as ROM and swelling allow. The brace is locked except for ROM exercises. The brace is locked at night and with walking for the first 10 days. These exercises should be done several times a day and not just during PT sessions. ROM is ideally from 0 degrees -> 90 degrees. The emphasis is on extension because flexion will always progress. E-stim is okay. I would encourage open communication at all times regarding the patient’s progress as well as any input that the therapist has, this should be a team approach.

Exercises:

1. Heel Slides
2. Active Assisted Knee Flexion/Extension in Sitting
3. Active Prone Knee Flexion
4. Long-Sitting Passive Knee Extension (towel roll under ankle)
5. Quad sets/Hamstring Sets
6. Ankle Pumps
7. SLR

Post-op Weeks 2-3

Patients can now begin using over-pressure with ROM exercises. The brace is allowed to be unlocked at all times after 2 weeks. Patellar mobilization should continue along with other ROM efforts. Gentle closed chain strengthening and proprioception exercises are initiated. The brace is discontinued after P.O. week 4 if adequate leg control is demonstrated. D/C crutches as willing and ROM allow. Lack of full extension requires supervised physical therapy intervention. Do not gain flexion at expense of extension. Normal gait heel/toe is stressed. Open chain quad extensions have no place in my ACL Rehab.

New Exercises:

1. Bilateral Mini-Dips (start of week 2)
2. One-Legged Biking
3. Sports Cord Mini-Dips (start of week 3)
4. Hamstring PRE’s
5. Static Standing Balance Progression (start of week 2)
6. Unilateral Leg Press (week 3)
7. BAPS Board (start of week 3)
8. Calf Work (start week 2)
9. Swimming (when wounds are healed); no whipkicks!
10. May start Stairmaster and stationary bike at start of week 3 if progressing well.

Essentially adding new closed chain exercises as knee allows. If therapist has other ideas, call me.

Post-op Weeks 4-6

ROM should continue aggressively. Strengthening is advanced with more challenging closed chain activity along with advanced proprioception work. Interval training is emphasized with aerobic exercises.

New Exercises:

1. Dynamic Proprioception Exercises with Thera-Band
2. Unilateral Mini-Dips-> Step-ups
3. Stairmaster/Seated Versa Climber if not already started

Note: If full extension is not present and maintained, please notify Dr. Collard at (314) 909-1359

Post-op Week 8

Upgrading of aerobic exercises, PRE’s, and closed chain exercises continues. Emphasize closed chain rehab.

New Exercises:

1. May start gentle jogging
2. Sport Cord walking progression

Post-op Month 3

Further upgrading as able. Do not do any cybex or other testing without consulting me. May do functional testing.

New Activities:

1. Slide Board
2. Sport Cord Resisted Step-ups
3. Hopping Progression
4. Quad PRE’s may exceed Hams by 50%
5. Begin controlled functional drills
6. May start gentle jogging as progression dictates
7. Potentially return to sports after seeing me.

Post-op Month 4

If not started, patient may begin a gradual, structured return to jogging. Emphasis is on adequate extension at heel strike and equal stride length. Patient may begin controlled simple skills at work. Sport specific rehabilitation is stressed. If patient is excelling in rehab, may consider return to sports at this time after evaluation by Dr. Collard. Any of the above may proceed somewhat faster as knee allows.

Post-op Month 5

ISOKINETIC TESTING MAY BE PERFORMED, but usually not needed. Patient may upgrade running to include sprinting and agility drills. Functional draining is also upgraded.

Post-op Month 6

Sport specific functional testing 6 month protocol, if not back to sports already.

RETURN TO FULL ACTIVITIES:
Six month on average, per Dr. Collard, with physical therapists’ approval. Both Dr. Collard and the physical therapists’ approval is based on performance in sports specific functional testing.