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
      • 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