ACL Reconstruction with Meniscus Repair

• This protocol follows ACL reconstruction with a medial or lateral meniscus repair. Its primary goal is to protect the reconstruction while progressing steadily to the pre-injury level of activity.
• It is a guideline: patients with additional surgery (for example collateral ligament repair) progress at different rates.
• Meeting the criteria of each phase matters more than the approximate duration.
• If pain or swelling increases, or motion decreases, at any time, reduce activity until the problem has resolved.

Phase I · 0–2 weeks postoperative

Goals

• Progressive decrease in swelling
• AROM: 0–90 degrees
• Prevent post-op knee stiffness
• Independent SLR without an extensor lag
• TDWB with crutches and brace

Activities

• PROM/AAROM/AROM for knee flexion/extension
  • Heel props, prone hangs, towel extensions for extension
  • Heel and wall slides for flexion, prone knee flexion
• Isometrics
  • Quad sets (0 degrees knee flexion)
  • Hip adduction (0 and 45 degrees knee flexion)
  • Hamstring sets (45 degrees knee flexion)
• Straight leg raises
  • All 4 planes
  • With immobilizer until able to SLR without extensor lag
• Pre-gait activities
• Proprioception
  • Weight shifting with UE support
• Patella mobilizations
• Modalities and rest to control pain and inflammation

Phase II · ~2–4 weeks postoperative

Goals

• Continued progressive decrease in swelling
• AROM 0–90
• Partial WB with crutches
• Independent SLR without extensor lag

Activities

• AROM/AAROM/PROM to maintain full knee extension and progress flexion (only to 90)
• Functional strengthening
  • OKC exercises: SLR (all 4 planes, progressive resistance), prone ham curls (knee 2” off table, light theraband resistance), SAQ extensions at 90–30 degrees
• Stationary bike (no resistance)
• Gait training / Proprioception with PWB
• Modalities as needed to control pain and inflammation

Phase III · ~4–8 weeks postoperative

Goals

• Swelling <1 cm at knee joint line
• AROM to 90 degrees until 6 weeks then progress to full ROM
• Progressive WB. D/C crutches at 6 weeks post op

Activities

• Progressive functional strengthening
  • Multi-hip/cable column for hip strengthening
  • Prone hamstring curls with progressive resistance
  • Squats with minimal resistance (standing on theraband and/or light barbell)
  • Lunges
  • 4”–6” step-ups, step-downs
  • Single leg press (<25% BW @ 4–6 weeks. <50% BW @ 6–8 weeks post-op)
  • Stationary bike, treadmill
  • Stairmaster (approximately 6 weeks post-op if no patellofemoral symptoms)
• Proprioception
  • BAPS, Rocker board
  • Unistands (floor and mini tramp)
• Progress ROM
• Modalities as needed to control pain and inflammation
• Gait retraining

Phase IV · ~8–12 weeks postoperative

Goals

• Pain/effusion free
• Symmetrical ROM
• Single leg press 70% of noninvolved extremity with 1 rep max
• Girth within 2 cm of non-involved extremity
• Pain-free 6” step down with good eccentric control

Activities

• Advanced CKC strengthening:
  • Leg press (unilateral and bilateral)
  • Squats: bilateral with barbell, unilateral with theraband
  • Lunges: backward, side and traveling lunges; lunges with plyoball overhead
  • Bike, stairmaster with progressive increase in resistance
• Proprioception: “Plus” outline on mini tramp and/or floor:
  • Jumping (approximately 12–16 weeks post-op)
  • Hopping (approximately 16–20 weeks post-op)

Phase V · 12 weeks to 6 months

Average person and recreational athlete

• At 50% of normal function.
• Continue with a strengthening program a minimum of 3 times per week for 6 months
• Recreational athlete should also participate in some light agility training to prepare for return to sport phase of rehab.

High-level athlete

• Progressive running program if the above criteria have been met. Cross train biking and pool activities.
• Focus on progressive strengthening, running, plyometric and pre-sport activities for preparation for the return to sport phase of rehab.

Some patients will have used up their insurance benefits by this point. That does not mean rehabilitation is finished: the therapist will set up a progressive home exercise program if needed, and joining a health club or gym at this stage is recommended to get the most out of rehabilitation.

Phase VI · 6–9 months

Criteria for return to sports (approximately 6–9 months post-op)

• Pain free
• Symmetrical ROM
• No effusion
• Quad Index > 90%
• Single leg press equal bilateral with 1 rep max test
• Jogging 2 miles pain free
• Functional hop testing 90% of non-involved extremity
• Y-Balance Test: composite score > 90%
• Functional bracing discussion
• Discussion with patient about confidence to RTS

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 University Orthopedics, Inc., Sports Medicine Division, "ACL Reconstruction with Meniscus Repair", Undated, published by William Beaumont Army Medical Center (reproduced with attribution; the clinical parameters are theirs, the wording is ours). Original: ACL Reconstruction with Meniscus Repair.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