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4. Pediatric and Adolescent Orthopedic Surgery
5. Overview
6. Knee Education Overview
7. ACL Protocol

Anterior Cruciate Ligament (ACL) Reconstruction Rehab Protocol

Note: WB, ROM, etc.. will be modified with meniscal repair

Meniscal repair only- 6 weeks, NWB

ACL with meniscus repair-TTWB 6 weeks then gradual increase WBAT

Immediate Post-op

                Long leg brace locked in full extension (at all times except for exercises) for        

                5 weeks

Stretching: prone hang/towel extensions

ROM (out of brace) : 0-120 degrees

Strengthening: quad isometrics/ co-contractions, SLR (all planes, flexing hip as long as full knee extension maintained), hamstring curls (prone/standing), gluteal isometrics, ankle pumps, knee extension (90 to 60 degrees)/proximal resistance

Add EMS (first hams/then quads) until no quad leg with SLR

Week 3

Long leg brace locked in full extension (at all times except Bledsoe for exercises)

Stretching: prone hang/towel extensions, patellar mobilization (especially superior)

ROM (out of brace): 0-120 degrees

Strengthening: as above, add wall sites, (1/4 squats, sit to stand: 2 to 1 leg) progressive closed-chain activities, and toe raises, and DCEMS when able to do SLR without extensor leg

Continue EMS to quads as needed

Conditioning: stationary bike (low resistance with toe straps), treadmill (forward/retro), swimming may be implemented but no vigorous knee motion should be allowed

Week 5

                Functional knee brace with exercise/sport if prescribed ( for 12 months)

Stretching: prone hang/towel extensions (until full extension maintained,    then discharge)

                ROM (out of brace): 0-135/140 (full)

Strengthening: as above, but increase knee extension (90 to 30 degrees) proximal resistance, begin eccentric quad exercises and hamstring isokinetic, and add weights to hamstring curls and SLR as tolerated (above thigh)

Conditioning: as above, but increase stationary bike (progressive resistance)

Begin single leg stance exercises for balance/early proprioception

Week 7

Strengthening: discharge SLR, initiate Nautilus (hamstring, quad 90 to 30 degrees, leg presses)

                Conditioning: ass StairMaster/cross country ski machine

                Progress proprioceptive training (single limb balance and control)

                Begin adding weight to closed chain exercises

Month 4

                Strengthening: increase knee extension (full range)

Conditioning: Double hops-single hops-jogging/running (when walking without compensation and demonstrating eccentric control)

Agility/sport- specific training (with brace if indicated: add plyometric training, cariocas, cutting, figure of 8’s ,etc

When exhibiting good control with straight line movement

Add fitter/slide board

Strength testing: isokinetic evaluation

Month 6

                Agility/sport- specific training

Strength testing: continue until torque/body weight goals are within 10%

Return to sport when:

                Full ROM and no joint effusion

Isokinetic test indicates quadriceps strength is 80% or more and hamstring strength is 85% or more of uninvolved leg

Successful completion of running program and of sport-specific agility program

                Satisfactory clinical exam and functional brace

                SLS time is within 10% of opposite leg