Post date: May 20, 2016 2:8:58 PM
Anterior Cruciate Ligament (ACL) Hamstring Graft Rehabilitation Protocol
Pre-Op Instructions
1. Gait training instruction with crutches.
2. Instruction in immediate post-op exercises.
Post-Op: Day of surgery.
1. Hinged brace locked at 0° or straight leg brace.
2. Ice & elevation of knee. Compression wrap should be worn to control swelling.
3. Range of motion exercises:
a. Ankle range of motion (ABC’s),
b. Heel Slides, and
c. Passive Patellar Mobilization.
4. Begin exercises as tolerated:
a. Quadriceps and hamstring sets,
b. Straight Leg Raises (SLR): Supine, Abduction, Adduction, Prone,
c. Seated knee extension, hip flexion, and terminal knee extension,
d. Touch down weight bearing with walker, and
e. Well body exercises.
f. No Active Hamstring Flexion Exercises for 2 weeks (Passive or Active-Assisted Only.)
5. Ice before and after exercise and 20 minutes every 2 hours while awake.
Post-Op: Day 1
1. Continue ice, elevation, and compression wrap.
2. Continue range of motion exercises 2 - 3 times per day and add:
3. Continue strengthening exercises and add:
a. Heel raises with balance assistance, and
b. Partial squats with balance assistance (transfer to chair)
4. Ice before and after exercises and 20 minutes every two hours while awake.
Post-Op: Day 2 - 7
1. Continue ice and elevation.
2. Continue range of motion exercises.
3. Continue strengthening exercises by utilizing PRE principle and add:
a. Weight to all SLR’s, Knee Extension, Hip Flexion, and TKE, and
b. Side Step-Ups.
4. Ice before and after exercise and continue use of compression wrap.
5. Physician examination 6 - 8 days post-op for evaluation and suture removal.
Post-Op: Week 1 & 2
1. Continue ice and elevation as needed.
2. May shower or bathe after sutures have been removed.
3. Continue range of motion exercises (Full ROM allowed).
4. Continue strengthening exercises and add:
a. Gait training program on smooth, flat surface, with gradually increasing weight bearing using walker/crutches
b. Prone lying and active knee flexion
5. Ice before, if indicated, and after exercise.
Post-Op: Week 3 & 4
1. May apply lotion to incisions sites using heel of thumb and pressure as tolerated.
2. Continue range of motion exercises.
3. Continue strengthening exercises utilizing PRE principles, add
b. Squats progressing to Single-leg parallel squats,
c. Calf Raises progressing to Single-leg, then elevated heel raises,
d. Balance and proprioception activities, and
e. StairClimber exercises.
4. Switch to Hinged knee brace till 6 weeks post-op or as directed by physician.
5. Stationary bicycle riding with seat height as low as tolerable with low resistance.
6. Can shift to single elbow crutch/stick on the opposite side with full weight bearing around 4 weeks.
Post-Op: Week 5-12
Continue range of motion exercises
Continue strengthening exercises utilizing PRE principles, add
a. Active Hamstring Curls,
b. Seated Leg Press 0° - 90°,
c. Squats in weight room with emphasis on form over weight,
d. Slide Board (week 6), and
e. Swimming with straight kicks only, after full wound healing.
3. Begin Jog program at 10 weeks post-op, with physician approval, on smooth flat surface, jog straight-a-ways only, walk curves. Slowly increasing time and/or distance. If painful or a limp is present, do not increase intensity until pain-free and gait is normal.
4. Start weaning off from the crutch/stick once hip abductor and knee extensor strength is good after 6 weeks.
Post-Op: Week 12 - 6 Months
1. Continue active exercises.
2. Begin functional activities after fitting of functional brace:
a. Light plyometrics,
b. Begin light cutting or agility activities, and
c. Begin sport specific non-contact drills.
3. Return to non-contact, non-competitive individual sports (running, swimming, cycling) at 3 to 4
months if contralateral strength is 85% or more.
4. Return to competitive sports (4 - 12 months) when:
a. Muscle strength is 85% or greater,
b. Range of motion is equal,
c. Girth measurements are equal, and
d. Knee is functionally stable.