ACL Reconstruction - Post Operative Rehabilitation Protocol

Post-operative ACL Reconstruction Rehabilitation Protocol from San Francisco Orthopaedic Sports Medicine Surgeon Dr. James L Chen, MD.

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We are located near Union Square in San Francisco:

450 Sutter Street, Suite 400
San Francisco, CA 94108
415-900-3000

[TommyJohn]

Post-op Meniscal repair #1
1. Attend Therapy about 1-2 weeks after surgery
2. Non WB first couple of weeks
3. Partial WB 4-8 weeks with crutches
4. Keep brace locked in knee extension the entire day, unlock brace whenever you are doing your exercises or sitting in car
5. Avoid knee flexion past 90-deg to avoid compressing meniscus and damaging the tissue
6. Lookout for signs of infections: redness, warm to touch, red streaks, fluid or puss leaking through the incision, excessive swelling that isn’t going away. Intense calf pain, squeeze calf and ankle DF causes pain - possibly DVT
7. Keep sterile strips on until they fall off or until MD takes them off or usually 2 weeks after they are put on. Keep dressings dry.
8. Reduce swelling
⁃ by keeping leg elevated above the heart
⁃ Ankle pumps
9. Important to get knee extension!
⁃ Avoid putting things under the knee such as a pillow otherwise you will move into knee flexion which we don’t want. We want to maintain full knee ext because that’s the harder and most important movement we need to obtain post-op.
⁃ If we don’t get full knee ext within 1-2 months then that person may never achieve full knee extension ever again


Early Post-op (0-2 weeks)
⁃ Control pain and swelling:

4 Stages of Rehab
1. Phase 1 (2-6 weeks)
2. Phase 2 (6-12 weeks)
3. Phase 3 (12-20 weeks)
4. Phase 4 (> 20 weeks)

Early Post-op (0-2 weeks)
⁃ Control pain and swelling:
⁃ PROM/AAROM
⁃ SLR 2x10 w/ 3-sec holds
⁃ Quad sets 2x10 w/ 3-sec holds
⁃ Short arc quads 2x10 w/ 3-sec holds
⁃ Heel slides within 0-45 deg
⁃ Ankle pumps with pillow under heel to reduce risk of blood clot

4 Stages of Rehab
1. Phase 1 (2-6 weeks)
• Gait Training with crutches PWB
• Get up to 90-deg of knee flexion rom
• Allow incision to heel: STM, PROM, resting ice elevation, patellar mobs
• Quad control/activation:
• quad sets
• short arc quads
• TKE with band in standing
• TKE with ball in standing
• Hip strengthening:
• 3 way clam shells
• Side lying hip abduction
• Standing 3-way hip arom

2. Phase 2 (6-12 weeks)
• Work on full ROM
• Normal patellar mobility
• Restoring normal gait
• Return to ADL’s

Treatment
• AAROM
• By 6-8 weeks you can work into more than 90-deg of rom
• Step ups/down
• Bosu step ups
• Lunges/squats up to tolerance
• Side steps w/band
• Balance training while standing in parallel bars

• Retro TM walks
• Heel taps 2-6 inch
• Eccentrics


3. Phase 3 (12-20 weeks)
• Lowering phase- descend stairs
• Eccentrics: Up 2/ Down 1 exercises
• TRX up 2 down 1
• Leg press up 2 down 1
• Heel taps on box
• Split Lunges with band unilateral
• Ladder drills (my videos)
• Mini hops with band
• SL hops fwd/back, side to side
• Leg Press hops
• Squats jumps with band

4. Phase 4 (> 20 weeks)
• Return to sport
• Jogging/sprinting on TM
• Agility
• Plyo jumps
• Full activity