ACL Autograft with Meniscus Repair Rehab

General Guidelines

• • Full PROM immediately but do not force flexion
  • Ensure you achieve full extension
  • Full patellofemoral 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
  • Hamstring autografts avoid concentric knee flexion exercises for 8 weeks
  • Full patellar tendon mobility once incision is closed (for patellar tendon autografts)
  • Avoid deep squatting for 6 months
  • Avoiding twisting on a planted foot for 6 months
  • No open chain knee extension for 6 months

Phase I — Weeks 0-8

• • TDWB x 3 weeks, Then PWB (50%) for 4-6 weeks (Brace locked in full extension for gait)

• • • • • 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)

• • Re-establish ROM with heel slides, ham/calf stretching, gravity assisted stretching
  • Start cycling program once flexion ROM is 110 deg or >
  • Start aqua jogging once incisions are closed
  • Quad setting with biofeedback if needed to reestablished quad set
  • Quad setting with directional SLRs (flexion/abduction/extension)
  • Ankle theraband exercise
  • Core exercises at 6 weeks (planks/sideplanks 10 x each for time)
  • At 4 weeks start swiss ball bridging 30 x 10-20 second holds
  • At 6 weeks start gentle prone quad stretching with strap
  • At 8 weeks start single leg machine press from 30-90 deg 4 x 10

Phase II – Weeks 8-12

• Normalize gait pattern
  • Initiate body weight squats
  • Initiate hip thrusts
  • Initiate balance program (start on ground and progress to unstable surfaces/eyes closed)   Start single leg bridges30 x 10 seconds
  • Start eccentrics with single leg machine press 40 x 10 second duration with weight lowering (continue 30-90 deg)
  • At 10 weeks start step-downs (reverse with eccentric control) 4 x 10 (small step height: 4-6 inches)
  • At 10 weeks add hypers with glute emphasis
  • At 10 weeks start SL hip thrusts
  • Continue with cycling and aqua jogging program
    • Continue with SLRs as needed
  • Continue stretching until completely symmetric ROM

Phase Ill- Weeks 12-20

• • Continue with phase Il activities
  • Start single leg closed chain exercise 4 x 10 each (ie single leg squats with forward reaches, single leg RDLs, single leg squats with rear-leg elevated, step-downs reverse, split-squats).
  • Add loads progressively (ie hold weight plate, med ball, or wear weighted vest).
  • Progress posterior chain exercises
  • Start dynamic warm-up drills at 12 weeks
  • Start dynamic lunges (forward, reverse, walking) at 16 weeks. Add loads progressively   If pressing strength is at 80% or greater of unaffected leg (test with 10 rep max) then begin running program at 16 weeks.
  • Begin with interval jogging on treadmill with feedback to normalize pattern
  • Progress to treadmill jogging
  • Move outdoors to running on track
  • Continue with core training progressively (add WB core exercises)

Phase IV — Weeks 20 to return to sport

• • Start agility training at 20 weeks
  • Start double leg plyos at 20 weeks (begin with broad jumps — take-off and landing must be fully symmetric to progress jump training). Progress to single leg plyos when double leg plyos are symmetric (at 22-24 weeks)
  • Initiate sprinting and return to sport drills at 24 weeks
  • Pass functional/strength testing and return to sport at 24 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 2.5mmKT-1000 test within 2.5mm