Week 1 -3

1.   After surgery, the incisions need to heal and the swelling needs to settle down.  It’s important to limit activities as much as possible until pain and swelling start to improve.  Ice and ice modalities are used liberally as well as elevation of extremity.   The pace of the postop rehab has to be individualized.
2.  Early ROM with the CPM machine will be started.  Motion needs to get to 90 degrees at least by the end of the first week.  Full extension exercises need to start.  Prone hangs for extension.  Heel slides are good.  Also knee extension with a roll towel under the ankle.

heel slides

3. Early quad work can begin.  Start with quad sets (10 x 10 secs for 10 times a day).  Electrical stimulation can be used to initiate contractions.  Once quad sets good can advance to straight leg raises (SLR’s).

SLR
4. Gait training with WBAT unless otherwise instructed in brace.  No limping!  Crutches until you can walk without a limp.  Very important to get full extension or walking off crutches difficult.

Week 3 – 6

1.  Continue with Week 1 – 3 goals until met.  Full range of motion especially extension important.  Continue ice modalities and controlling activities for swelling.  At 3 weeks if good quad contraction is obtained you can wean out of the brace.  Also can wean off crutches once good gait pattern is established.  You need to have a good heel – toe gait.  No limping!

2.  Continue quad strengthening.  I prefer closed chain kinetic quad strengthening such as leg presses and squats because it is less hard on the patellofemoral joint and it help with proprioception.

Leg presses

3.  Can start aerobic conditioning such as stationary bike or elliptical machine.

4. Patella mobilization especially superior and inferior.

Week 6 -12

1.  Closed chain kinetic quad strengthening with goal of side to side symmetry  -   Leg presses, wall squats, etc.  Can start hamstring strengthening at 6 weeks.

2.  Continue ice after activities.

3.  Aerobic activities okay –  stationary bike, regular bike, elliptical, pool.  No running or sports yet.  The ACL graft has not matured enough for sports.

3 months

1.  Continue working towards full quad and hamstring strength.  Usually at this time a functional brace will be fitted if quad atrophy gone.  Once brace is obtained, can start straight line gradual jogging.

2.  Straight line jogging can start once you get the brace.  Again this should be a gradual process with good techniquenot pushed past the point of quad fatigue..  Can continue other aerobic activities.  Ice after activities.

4 – 5 months

1.  Make sure all of the above goals are met.  Can add backward running.  Box 4 drills.  No competitive pivoting sports yet!

2. Neuromuscular training should be concentrated on here including plyometrics or jump training, agility drills, and when cleared by me, sport-specific drills.

3.  Sportsmetrics – geared toward female athletes.

6 months

1.  Gradual return to sports activities.  Need to have all of the above goals met.  Can take up to a year for full confident return.

2.  I recommend you wear the functional brace for the first year of sports return.

3.   Continue neuromuscular training you’ve been taught.