ACL Reconstruction, Bone-Tendon-Bone Autograft or Allograft

Post-op days 1–14

Exercises

• Dressing:
  • POD 1: Debulk dressing, TED Hose in place
  • POD 2: Change dressing, keep wound covered, continue TED Hose
  • POD 7–10: Sutures out, D/C TED Hose when effusion resolved
• Brace x 4 weeks – Locked in extension for ambulation
  • Open to available range when pt has good quad control (no extensor lag)
• Crutches – weight bearing as tolerated (WBAT) in brace (D/C when gait is normal – generally at 2 weeks)
• Patellar mobilization (teach patient)
• Calf pumping
• AAROM 0–90 degrees (passive extension, active flexion, heel slides)
• Passive extension with heel on bolster or prone hangs
• Electrical stimulation in full extension with quad sets and SLR
• Quad sets, Co-contractions quads / Hamstring
• Straight leg raise (SLR) x 4 on mat (in brace if poor quad control)
• Mini squats – 0–45 degrees in parallel bars
• Weight shifts
• Total Gym (level 3–5) – Mini squats 0–45 degrees
  • Passive flexion to 90 degrees max (push up with opposite leg)
• Leg press 0–45 degrees with light resistance (up to ¼ body weight)
• Hamstring curls – Carpet drags or rolling stool (closed chain)
• Double leg heel raises
• Parallel bar ambulation – Forwards / backwards / lateral
• Stationary bike for ROM – Complete cycle as able
• Ice Pack with knee in full extension after exercise

Goals

• Full passive extension
• Flexion to 90 degrees
• Good quad control

Weeks 2–4

Exercises

• Brace x 4 weeks – Open to available range
• Crutches – WBAT, D/C when gait is WNL
• Continue appropriate previous exercises and following ex without brace
• Scar massage when incision healed
• AAROM, AROM through full range as tolerated
• Electrical stimulation – Continue as needed
• SLR x 4 on mat – Add light ankle weights if quad control is maintained
• Wall squats – No knee flexion past 45 degrees
• Total Gym – Progress levels of Mini-squats, 0–45 degrees
• Leg Press 0–45 degrees with resistance no more than ½ body weight
• Hamstring curls on weight machine with light resistance
• Forward, lateral and retro step downs in parallel bars
  • No knee flexion past 45 degrees (small step)
• Single leg heel raises
• Proprioceptive training – Single leg standing in parallel bars
  • Double leg BAPS for weight shift
• Stationary bike – Progressive resistance and time
• Treadmill – Forwards and backwards walking
• Stretches – Hamstring, Hip Flexors, ITB

Goals

• ROM 0–110 degrees
• No effusion
• No extensor lag

Weeks 4–6

Exercises

• D/C Brace
• Continue appropriate previous exercises
• PROM, AAROM, AROM to regain full motion
• Standing SLR x 4 with Theraband bilaterally
• Mini squats, Wall squats 0–60 degrees – Progress to single leg
• Leg press 0–60 degrees with resistance no more than ½ body weight
• Forward, lateral and retro step downs 0–60 degrees (medium step)
• Proprioceptive training – Single leg BAPS, ball toss and body blade
• Elliptical trainer
• Pool therapy – Walking / running (no kicking)

Goals

• Full ROM
• Normal gait

Weeks 6–9

Exercises

• Continue appropriate previous exercises
• Wall squats 0–90 degrees
• Leg press 0–90 degrees with resistance as tolerated
• Hamstring curls with resistance as tolerated
• Forward, lateral and retro step downs 0–90 degrees (large step)
• Hip weight machine x 4 bilaterally
• Proprioceptive training – Grid exercises
• Stationary bike – 15–20 minutes at a time, at least 70 rpm
• Treadmill – Walking progression program

Goals

• Walk 2 miles at 15 min/mile pace

Weeks 9–12

Exercises

• Continue appropriate previous exercises with progressive resistance
• Fitter
• Slide board
• Functional activities – Figure 8s, gentle loops, large zigzags
• Stairmaster – Small steps
• Pool therapy – No swimming laps
• Quad stretches

Goals

• Walk 3 miles at 15 min/mile pace

Months 3–4

Exercises

• Isokinetic testing at 180 and 300 degrees/sec – Must have 80% of opposite leg to clear for straight line running
• Continue appropriate previous exercises
• Knee extension weight machine
• Short arc quads
• Agility drills / Plyometrics
• Treadmill – Running progression program if cleared
• Pool therapy – Swimming laps

Goals

• Run 2 miles at easy pace

Months 4–6

Exercises

• Repeat Isokinetic testing as needed
• Continue appropriate previous exercises
• Sit-up progression
• Running progression to track
• Transition to home / gym program

Goals

• Return to all activities

NO CONTACT SPORTS UNTIL 6 MONTHS POST-OP

Home exercise sheet · knee post-op phase I

Perform exercises below frequently: 30 reps, 3–5x a day

(The exercise illustrations on this page were not captured by the text extraction.)

Abbreviations

AROM / AAROM / PROM: active / active-assisted / passive range of motion. ROM: range of motion. ER / IR: external / internal rotation. ABD / ADD: abduction / adduction. FLEX / EXT: flexion / extension. WBAT / PWB / TTWB / NWB: weight bearing as tolerated / partial / toe-touch / non-weight bearing. SLR: straight leg raise. HS: hamstrings. ITB: iliotibial band. UE / LE: upper / lower extremity. UBE: upper body ergometer (arm bike). BAPS: balance board. BFR: blood flow restriction training. PREs: progressive resistance exercises. D/C: discontinue. prn: as needed. POD: post-operative day. TENS: transcutaneous electrical nerve stimulation. ADLs: activities of daily living.

Source

Adapted from Galland/Kirby, adapted from William Beaumont Army Medical Center, Physical Therapy Section, "ACL Reconstruction - Bone-Tendon-Bone Auto Allograft", Undated, published by William Beaumont Army Medical Center (a work of the U.S. Government in the public domain). Original: ACL Reconstruction - Bone-Tendon-Bone Auto Allograft.pdf.

This protocol is general guidance for the rehabilitation team and does not replace the specific plan, restrictions and follow-up we set together. Your own situation may differ: if anything here does not match what we talked about, what we talked about wins, so please ask me.

Current version and every other protocol: aaronweymd.com/post-op-protocols