ACL Post-Operative Rehabilitation

ACL Hamstring Tendon Graft Post-Operative Rehabilitation

Dr. Carey Winder
Baton Rouge Orthopaedic Clinic

ACL protocol is the same as bone patellar tendon bone except for the following:
1. When performing heel slides, make sure that a towel is used to avoid activating the hamstring muscles
2. Do not perform isolated hamstring exercises for 6 weeks
3. Partial weight bearing with crutches for 4 weeks

Week 1:
- Patient begins physical therapy 3-5 days post-op
- Initial therapy treatment consists of the following:

• EMS/bio feedback to quads


• Quad setting for 10 minutes


• SLRs for 5 min


• HSS sitting in chair (30 sec hold, 5 reps)


• Calf stretching against wall (30 sec hold, 5 reps)


• Patellar mobilization (emphasize superior glides)


• 90-40 open chain manual resistance


• ROM Passive: progress as tolerated (DO NOT MANUALLY FORCE ROM!)

To increase flexion:
May perform heel slides, wall slides, or chair flexions (wall slides preferred for hamstring grafted patients)

To increase extension:
May perform HSS, calf stretches, prone extensions (use biofeedback to relax the
hamstrings or manually teach relaxation of the hamstring during prone stretch)

Weight bearing:

• Weight bearing as tolerated with crutches.


• Continue use of crutches until gains quad control (3-6 weeks), then go to one
  crutch before FWB with no assistive devices

Cycling:

• May begin stationary cycling when can flex to 110 degrees (DO NOT USE STATIONARY BIKE TO INCREASE FLEXION!)

Bracing:

• Knee immobilizer when walking with crutches

Week 2 to 6:
- Will fit with a functional brace in the office. Wear the brace when ambulating to help protect from hyperextension injuries

• Continue above exercises


• Begin leg press from 90 to 20 degrees both legs.


• Progress to single leg press, stopping at 40, 60, and 90 degrees. When
  stopping hold position for 5 seconds.

Bracing:

• We measure for a functional brace such as the DonJoy Defiance at 3-6 weeks post-op:


• We use the brace to protect the patient from possible hyperextension injuries.

Begin proprioceptive training:

• Utilize the K.A.T. for balance, “stork” single leg balance with knee flexed to 20-30 degrees. Addition of biofeedback to enhance the VMO contraction is helpful. Use of sports cord may be instituted as long as patient has good quad control.


• Pool Walking Okay – make sure patient realizes to walk only and not to perform whip kick

Weeks 6-12:

• Lateral step ups


• Progress with proprioceptive training


• May begin running at 8-12 weeks when ROM normalizes and pain and swelling allow.


• Start on trampoline, progress as tolerated to cushioned surface, then hard surface.

Isokinetic test:

• At 180 and 300 degrees per second at 12 weeks.


• Include results in report to M.D.

3 to 6 months:

• Continue with above and may add partial squats, forward lunges with straight bar.


• Progress as tolerated.


• Do not perform if patient has patellar femoral symptoms!

6 to 12 months:

• Begin sport specific drills


• Return to activity based on KT-1000 scores and full ROM, Biodex test, and functional tests.