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)
            • 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