ACL Reconstruction — Rehabilitation Protocol

Dr Jobe Shatrov
MBBS (Hons), BSc. (Physio). Grad. Dip. (Surgical Anatomy), FRACS, FAOrthoA
Orthopaedic Surgeon, Knee Surgery
Prehab (2–6 weeks before surgery)
Goals: Settle swelling, regain full extension, flexion to at least 120, activate quadriceps, learn crutch use.
Exercises: Heel slides, quads sets, straight-leg raises, stationary bike (no resistance if swollen), hip and core work.
Phase 1: Weeks 0–2
Goals: Protect graft, control pain and swelling, achieve full extension, flexion to 90, normalise gait with aids.
Weight-bearing: As tolerated with crutches unless meniscal repair or other instructions.
Brace: As directed if combined procedures.
Exercises: Ankle pumps, quads sets, SLR, heel slides to 90, patella mobilisations, gentle bike when wounds are healed.
Criteria to progress: Full passive extension, flexion ≥ 90, minimal swelling, safe straight-leg raise without lag.
Phase 2: Weeks 2–6
Goals: Flexion to 120+, restore normal gait, build early strength and balance.
Exercises: Air squats to chair height, step-ups, bridges, hip abductor work, bike progress, pool walking once wounds are healed.
Criteria to progress: Pain controlled, near-normal gait, flexion ≥ 120, good single-leg stance.
Phase 3: Weeks 6–12
Goals: Strength, balance, movement control.
Exercises: Leg press within comfort, Romanian deadlifts, lateral step-downs, split squats, controlled hopping drills without impact, proprioception.
Running prep tests: Full extension, flexion within 10 of the other side, pain and swelling minimal after sessions, good single-leg control.
Phase 4: Months 3–6
Goals: Return to running and light agility when ready.
Running: Start jog-walk intervals on flat ground, progress time and frequency before speed.
Agility: Low-level change of direction and mini-hops when strength symmetry improves.
Criteria to progress: Quadriceps strength ≥ 80% of other side, quality single-leg squat, hop control without pain or swelling flare.
Phase 5: Months 6–9+
Goals: Sport-specific training and return to play testing.
Testing examples: Strength ≥ 90% symmetry, hop tests ≥ 90% symmetry, movement quality on cutting and landing tasks, no effusion.
Return to pivoting sport: Usually 9–12 months, guided by testing rather than time.
Red flags: Fever, calf pain or swelling, wound discharge, locking, giving way, chest symptoms. Seek urgent review.
Your plan may differ. Follow the instructions you receive from Dr Shatrov.
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