Accelerated ACL Rehabilitation

This is Dr. Khan’s protocol for accelerated ACL rehabilitation. The terminology used is more specific for a physical therapist.

Post-op Week 1

• Drop lock knee brace in locked position except when exercising. Remove brace for therapeutic exercises and continuous passive motion.
• WBAT with crutches in post-op brace locked in full extension, unless meniscus repair, then no weight bearing for one month.
• Full ROM: emphasize full extension.
• No Prone hangs.
• Quad sets.
• Heel slides/AAKF dangling.
• SLR in brace until patient is without a lag.
• Hip abduction/adduction/flexion and extension.
• Isometric quadriceps muscle contraction in complete/supported extension: biofeedback/electrical stimulation.
• Straight leg raises in 4 directions without extension lag, resistance above the knee. If lag, patient may perform straight leg raises with brace locked.
• Electric stimulation for quad re-ed.
• Patella mobilization.
• Home exercise program instruction.

Post-op Weeks 2-3

• Continue ambulation in brace/switch to functional knee brace when SLR without a lag.
• Progress to 1 crutch or cane as tolerated for non repair PTS.
• Advance SLR’s.
• Continued Hip PRE’s.
• Initiate gentle hamstring stretching.
• Hamstring isometrics.
• Closed chain knee extension 90 to 30 degrees (leg press, wall squat, tigney).
• Bicycle- okay with repair at this time.
• Toe raises.

Post-op Weeks 3-5

• D/C assistive device when gait is non-antalgic.
• D/C brace when patient can SLR without lag.
• Continue SLR & hip and calf PRE’s.
• Progress weight on closed chain quadriceps exercises 90 to 30 degrees.
• Hamstring isotonics as tolerated.
• Proprioception activities: BAPS, balance board, single limb stance.
• Treadmill (forwards/backwards) and stair master as tolerated.

Post-op Weeks 6-12

• Continue closed chain quadriceps strength.
  • Stair master
  • Forward/Lateral step-ups and step downs
  • Leg press concentric and eccentric:
    • Lunges
    • Squats
    • Tigney
• Initiate open chain 90-35 degrees.
• Progress isotonic hamstring strength.
• Progress endurance Bike/Treadmill/Stair master.

Post-op Weeks 12-15

• Continue progressing strength, flexibility and endurance as tolerated.
• Begin light agility drills:
  • Fitter
  • Carioca
  • Figure 8
• Aqua running.

Post-op Weeks 16-20

• Progress speed and intensity of agility drills.
• Continue strength/flexibility/endurance.
• Begin forward/backward running
• Running program criteria:
  • Pain and edema free
  • Full ROM
  • Quad strength 85% opposite lower extremity (isokinetic or leg press max repetition test)

Post-op Month 6+

• Return to competitive sports.
• Knee sleeve or functional brace as needed.
• Continue strengthening program until one year post-operative.