ACL Allograft Rehab

General Guideline

• Full PROM immediately but do not force flexion
• Achieve full extension immediately
• Achieve full patellar mobility all planes
• Reestablish proper motor control patterns especially with single leg closed chain movements and single leg plyometric/agility movements. Stress proximal control at hip and distal control at subtalar joint. If subtalar joint cannot be controlled (eversion collapse) consider orthotics
• No open chain leg extension for 6 months
• If non-athletic patient then make adjustments to protocol (may not progress past phase Il)

Phase I — Weeks 0-8

• WBAT with brace locked full extension x 1 weeks
  • IF MENISCUS REPAIRED THEN
    • Weeks 0-3: TDWB, Brace locked full extension (permit AROM 0-90)
    • Weeks 4-6: PWB 50%, Brace locked full extension (permit AROM 0-full)
• Normalize gait pattern by 4th week
• Re-establish ROM with heel slides, ham/calf stretching, gravity assisted stretching
• Utilize prone hangs/belt fixation to achieve up to 5 degrees of hyperextension
• Start cycling program once flexion ROM is 110 degrees or >
• Start deep water jogging program once incisions are closed
• Quad setting with biofeedback/NMES
• SLRs into flex/abd/ext (do not perform SLRs with lag at 5 degrees or >)   Ankle theraband until FWB
• Core exercises at 6 weeks (planks/side planks etc.)
• At 6 weeks initiate body weight squats above 45 degrees of flexion (hip dominant squat technique with appropriate hip extension)
• At 6 weeks initiate swiss ball bridging
• At 6 weeks initiate single leg cybex press from 90-20 degrees

Phase Il — Weeks 8-12

• Must have full ROM, normal gait, plus quad control
• Add prone/standing quad stretch plus 1/2 kneeling hip flexor stretch  
• Balance program (progress to flexed knee, unstable surfaces, eyes closed)
• Single leg bridges (when strength allows)
• Body weight hip thrusts with isometric holds at top
• Eccentrics with single leg cybex press (10 second eccentric contractions), continue 90-20 degrees
• At 8 weeks add hypers and reverse hypers
• At 10 weeks add RDLS with goblet position for load add progress to barbell
• At 10 weeks add multi-hip for flex/abd/ext
• Continue cycling and water jogging programs
• Continue with SLRs and progress load up to 51b ankle weight

Phase Ill – Weeks 12-20

• Continue with appropriate phase Il exercises
• Increase squat depth to 90 degrees
• Dynamic warm-up drills (walking high kicks, walking hip flexion with holds)   Start low intensity single leg closed chain exercises (small angle single leg squats, reverse step-downs from low step, split squats, single leg RDLs)   Lateral monster walks with mini band above knees
• At 16 weeks progress intensity of single leg closed chain exercises (greater depth plus add load)
• At 16 weeks add lunges (forward, walking) plus add loads
• At 16 can begin running program if strength is at 80% or > of unaffected leg (test with IORM on the cybex press)
• Begin with interval jog/walk on the treadmill with cuing to normalize pattern  
• Progress to treadmill jogging
• Move outdoors on track or level street (avoid hills)
• Progress core program (add WB core exercises)

Phase IV — Weeks 20 to return to sport at 6-8 months

• Initiate agility training at 20 weeks
• Initiate double leg plyometrics at 20 weeks
• Progress to single leg plyometrics at 24 weeks
• Progress to non-contact sports drills at 24 weeks
• Pass sport test and return to sport at 28-32 weeks or when released by MD
• Pressing strength at 90% or greater
• Symmetric with single leg unsupported squat
• No faulty movement patterns
• Triple hop test at 85% or greater with symmetric movement quality
• KT-IOOO test within 2.5mm