Unless noted otherwise, this protocol applies to all patellar tendonlhamstring, primary/revision cases. If a mernscal repair has been performed simultaneously, patients are to ambulate (WBAT) in their immobilizer or brace locked in extension for one month postoperatively. The remainder of the protocol is similar except that closed chain activities should be performed in NO GREATER THAN 90 DEGREES of knee flexion (e.g. no exercise bike) during the first six weeks in order to protect the repair. There are NO ROM limits with partial meniscectomies unless otherwise indicated.

Date: Rt/Lt ACL reconstruction
Graft:  Meniscal Repair: Y/N
PHASE 1. Symptom Resolution
(POD #5-7 thru POW #2-3)
Goals:  control pain/inflammation
independent quad control
normalize gait (wean from immobilizer/crutches)
near normal AROM
Activities:  cryotherapy/modalities for inflammation
ROM (unrestricted), emphasize early full active extension,
quad control and strengthening:
Q sets, TKE, SLR when no lag
gait training: WBAT with crutches
passive patellar mobilization
clean/dry dressing changes pm
immobilizer when not exercising
Frequency:  BIW to TIW
Criteria to Progress: minimal inflammation
heel-toe gait without assist; AROM approx.. 0-100
adequate SLR
PHASE II: Baseline Conditioning
(POW #2-3 thru 12)
Goals:  normalize ROM
improve strength/endurance
*begin neuromuscular re-education
Activities: eliminate crutches/immobilizer
correct ROM deficits
*c1osed kinetic chain exercises
neuromuscular re-educationl/proprioception
Frequency: 2-3 visits + HEP, follow-up prn
PHASE III: Advanced Conditioning
(POW #12 thru 18)
Goals:  correct strength/endurance deficits
agility training
Activities:  continue Phase II activities
begin jogging/running
agility drills
advanced neuromuscular re-education
Frequency:  2-3 visits + HEP, follow-up prn
PHASE IV: Sport-specific Conditioning
(POW #18 thru24)
Goals: preparation for return to unrestricted activities
Activities:  sport/job specific activity simulation
establish maintenance flexibility/strength/endurance program
Frequency: 2-3 visits + HEP, follow-up prn
Precautions: *OTS functional brace to be worn during Phase IV rehab.
(ordered by M.D.); brace for cutting and pivoting sports
during 1st year