Post Op Day 1 2 Weeks 2. Prone Passive flexion 3. Passive knee extension 1. Full passive extension 2. Flexion 0-90 degrees 3. Actively able to set quads 4. Ambulate without crutches, including stairs 1. Ankle pumps 2. SLR Flexion, adduction and abduction 3. Quad sets with/without Russian muscle stim 4. Standing weights shifts 5. Mini Squats 1. Hamstring (Light, Passive) 1. Ice, ES, Elevation, Compression 2. Ice with knee in Extension 2 4 Weeks (Maximum Protection Phase) 2. Prone Passive Flexion 3. Bike ROM Only 1. Enough quad strength to control external forces and protect graft 2. Decrease swelling 3. ROM 0 125 degrees at week 4 4. Prevent Quad Atrophy 5. Maintain passive knee extension 6. Discontinue crutches 7-10 days Post-op ACL-R Hamstring Page 1
1. SLR (Four planes) 2. Mini Squats 0 45 degrees 3. Weight Shifts 4. Bike for ROM 5. Leg press 0 65 degrees 6. Stork stand progression **At week Four** 1. SLR add weight not to exceed 10% BW above the knee 2. H2O treadmill walking without resistance 3. Stairmaster short stroke low resistance 4. Step-up/downs (CKC) height based on quad quiver 5. Closed chain TKE s 6. KT 2000 test Hamstring and calves Ice, ES, Compression and elevation Weeks 5 10 2. Prone Flexion (Active) 3. Bicycle 1. Full ROM 0-140 2. Increase quad strength for function. Active progression 3. Protect graft/healing constraints 4. Discontinue Drop lock brace 1. Continue with Week 4 programs 2. Hamstring curls light resistance with short arc 3. H2O treadmill progression from walk to light jog 4. H2O Pool light freestyle kick 5. Standing lunge program to walking lunge ACL-R Hamstring Page 2
6. Increase proprioceptive awareness 7. Bike/Stairmaster for cardio fitness 1. Hamstrings and calves 1. Ice/ES/Elevation Weeks 10 16 (Moderate Protection Phase) 1. Maximum strengthening for quads and lower extremity 2. Protect patellofemoral joint 1. Multi-Hip 2. Knee extension (Short Arc = 90-40 degrees) pain free limits 3. Hamstring curls short arc (ECC Control) 4. Mini squats (0-45) 5. Leg press 0-65 degrees 6. Toe- Calf Raises 7. Walking lunges 8. Side Lunges 9. Squats 0-45 degrees 10. CKC barbell high step 11. CKC step-ups/downs front/side 12. Proprioceptive and balance progression **Isokinetic testing at Week 12** (120 degrees/180 degrees per second) Cardio 1. Bike 2. Stairmaster (Short Step) 3. H2O treadmill (Walk run progression) Calves and Hamstrings, IT band Criteria for next phase progression 1. 75 80 % of contralateral side 2. Full ROM 3. No Swelling ACL-R Hamstring Page 3
4. No quiver with lunge, step-ups/downs Weeks 16-24 1. Develop L.E. power, strength and endurance 2. Return to functional and athletic activities 1. Eccentric quad exercises 2. Short Arc knee extensions (pain free limits) 3. CKC barbell high step 4. CKC squats, leg press 5. Multi-Hip 6. Plyometric/agility progression a. Rope Jumps (hops, skips, single leg hops) b. Box Jumps c. Ladder drills d. Jumps, Hops and skips 7. Hamstring curls, eccentric load 8. Negative calf raises with knee at 5 to 10 degrees Running and Functional Progression 1. Continue treadmill progression walk/run to running 2. Supplement H2O treadmill for off days 3. Bike for cardio 4. Cone drills 5. Shuttle runs 6. Agility drills (cardio, back pedals, change of direction) 7. Personal sport related drills for functional training 8. Proprioception related activities a. Swiss ball b. Balance Boards c. Rocker Boards Lower extremity hamstrings, calves, IT band, piriformis Criteria for athletic participation return 1. Satisfactory orthopedic exam 2. Full ROM (pain Free) 3. No Joint effusion ACL-R Hamstring Page 4
4. Isokinetic test quads within 85% of contra lateral and hamstrings 90% 5. Hope test within 10% of contra lateral side for distance and timed. Return to Activity Phase Month 6-7 1. Achieve maximal strength and endurance 2. Return to sport activities **Continue strengthening program for one year from surgery** 4 Quads 4 Strength Knee Extensions Hamstring Curls Wall Squats Calf Raises Leg Press Hip Abduction Step-ups Hip Adduction 4 Endurance 4 Stability Bicycle High Speed Hamstrings Stair master High Speed Hip Flexion/Extension Nordic Track Balance Drills Swimming Backward running ACL-R Hamstring Page 5