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AnteriorCruciateLigament(ACL)ReconstructionProtocolOverview:Thisprotocolisacriteria-basedprotocol,withagoalofmaximizinghealingandstrengthrecovery,whileminimizingriskofre-injury,sotheindividualcanreturntowork,sportorrecreationalactivitiesasquicklyandsafelyaspossible.Ifaclinicianrequiresassistanceintheprogressionofapost-operativepatienttheyshouldconsultwiththereferringsurgeon.
**Thisisasummaryofaclinicalreferenceprotocol,usethelinkbelowtoviewtheprotocolinitsentirety**
Post-OperativePhaseI:Approximatelyday1to14Goals:
• A/PROM0-90degrees• Controlswellingandpain(cryotherapyandelectricalstimulation)• Restorepatellamobility• WBATwithcrutches&brace.Discontinueuseofcrutchesbyday10-14
Brace/AssistiveDevice:• LockedinfullextensionorasdirectedbyMD• Discontinuebraceoncevoluntaryquadcontrolisdemonstrated
Treatment:• Quadsets(NMEStoaideinquadcontrol• Gastroce/heelcord/hamstringstretching• Stationarybicycle• Activeandpassivekneeflexionexercisestotolerance,notpushed(to90degreesbyday5-7)• Ankleresistanceband-all4directions
CriteriaforenteringphaseII:• Fullpassivekneeextension• Minimaljointeffusion• QuadricepsvoluntaryinitiationwithquadsetandSLR• A/PROMkneeflexionto90degrees
Post-OperativePhaseII:ApproximatelyWeeks2to4Goals:
• A/PROM0-110/120degrees• PerformSLRwithnoextensionleg
Brace/AssistiveDevice:• Discontinueuseofcrutchesbyday10-14• Discontinuebraceoncevoluntaryquadcontrolisdemonstrated
Treatment:• Closedkineticchainquadricepsstrengtheningactivitiesastolerated(wallsits,step-ups,minisquats,leg
press90-30degrees)• Quadricepsisometricat60degreesand90degrees• Singlelegbalance• Hamstringcurls• PROMexercises0-110/120degrees• Straightlegraises(Flexion,Abduction,Adduction)
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CriteriaforenteringphaseIII:• Noeffusion• ROM0-110/120degrees• NoextensionlagwithSLR
Post-OperativePhaseIII:ApproximatelyWeeks4to8Goals:
• Restorenormalgait• RestorekneeROMto0-125degrees• NOpain• QuadricepsandHamstringstrengthto>80%ofwellleg• Enhanceproprioception,balance,andneuromuscularcontrol
Treatment:• ContinuephaseIIexercisesespeciallyclosedkineticchain• Stair-steppermachine• Progresslateralsteppingandlateralstepdownexerciseswithresistancebandsonthedistalfemur
creatingamedialpull• Advancecorestabilizationexercise• Perturbationtraining-singlelegbalanceàstablevs.unstablesurfaces
CriteriaforenteringphaseIV:• Normalgaitpattern• PROM0-120degrees• Minimalswelling/inflammation
Post-OperativePhaseIV:ApproximatelyWeeks8to10Goals:
• Fullrangeofmotion• Avoidoverstressingthegraft
Treatment:• Outdoorbikingprogram-avoidhills• ContinuephaseIIIexercisesifappropriate• Continueclosedchainstrengthening
Criteriaforenteringphasefive:• Minimum10weekspostoperative• Nopatellofemoralpain• Sufficientstrengthandproprioceptiontoinitiaterunning• Minimumof120degreesofflexion
Post-OperativePhaseV:ApproximatelyWeek10to16Goals:
• Protectthepatellofemoraljoint• Avoidoverstressingthegraft• Improvestrength,endurance,andproprioceptionofthelowerextremitytoprepareforsportactivity
Treatment:• Initiatejoggingprogram• Beginswimmingifdesired• Isokinetics-midrangespeeds(120degrees/sec-240degrees/sec• ContinueflexibilityandROMexercisesasappropriateforpatients
Linktoclinicalreferenceprotocol
