Knee Protocol

ACL Reconstruction Rehab Protocol

Stage I
0-2 weeks

  • Patellar mobilizations (emphasize superior/inferior glides)
  • Motion control brace 0-90
  • Quad sets/straight-leg raises all planes (emphasize straight-leg raise without extension lag)
  • Prone/standing hamstring curls
  • Passive extension (emphasize full extension)
  • Prone hangs
  • Pillow under heel
  • Passive, active, and active-assisted range-of-motion knee flexion
  • Wall slides
  • Sitting slides
  • Prone towel pulls
  • Edema control—compression pump
  • Electrical stimulation for muscle re-education if poor quadriceps set
  • Cryotherapy
  • Partial weight-bearing 50-75% with crutches or weight-bearing to tolerance without crutches if motion control brace locked in full extension
  • Sleep in brace locked in extension
  • Goals:
  • Full knee-extension range of motion
  • 90 knee-flexion range of motion
  • Good quad set
  • Emphasize normal gait pattern

Stage II
2-4 weeks

  • Motion control brace full range of motion
  • Progress range of motion to 120 by 4 weeks
  • Progress straight-leg raises and prone/standing hamstring curls with weights
  • Bike for range of motion, begin low-resistance program when range of motion adequate
  • Stool scoots
  • Full weight-bearing with crutches, discontinue crutches when ambulating without limp
  • Begin double-leg bio-mechanical ankle platform system, progress to single-leg
  • Begin double-leg press with light weight/high repetitions
  • Wall sits at 45-degree angle with tibia vertical; progress time
  • Lateral step-ups (4 in.) when able to perform single-leg quarter squat
  • Hip machine and hamstring machine when able to perform straight-leg raises with 10 lbs.
  • Treadmill (forward and backward) with emphasis on normal gait
  • Knee extension 90-60 degrees (sub-maximal) with manual resistance by therapist

Goals:

      • Range of motion 0-120 degrees
      • Full weight-bearing without crutches, no limp

4-6 weeks

  • Progress to full range of motion by 6 weeks
  • Begin Kin-Com hamstring progression (isotonic/isokinetic)
  • Begin Kin-Com quad work 90-40 isotonics with antishear pad
  • Stairmaster (forward and backward)
  • Progress closed-chain exercises
  • At 6 weeks, begin Kin-Com quad work 90-40 isokinetics (start with higher speed and work endurance)
  • Aquatic exercises

8-10 weeks

  • Progress above exercises
  • Slow-form running with sport-cord (forward and backward)
  • Isokinetic quad work at different speeds (60, 90, 120)
  • Begin lunges
  • At 10 weeks, begin Fitter, slide board
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