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 ACL Hamstring Reconstruction Surgical Rehabilitation

Phase I (Surgery to 2 weeks postoperative)

Appointments

• Home exercise program will begin after surgery – 2 weeks

Rehabilitation Goals

  • Protection of the post-surgical knee

  • Range of motion: full extension – 100 degrees flexion

  • Normalize quad activation

  • Eliminate effusion

Precautions

  • Crutches for the first 48 hours if obtained nerve block

  • WBAT after 48 hours

  • Remain in brace to protect graft

Suggested Therapeutic Exercise

  • Ankle pumps

  • Passive knee extension to zero

  • SLR 4 directions with brace

  • Knee extension 0 degrees

  • Quad sets

  • Hamstring stretches

  • Patellar mobilizations

  • Standing weight shifts/mini\squats

Cardiovascular exercise

• Upper body circuit training or upper body ergometer (UBE)

Progression Criteria

  • 0-90 degrees range of motion

  • No effusion

 

Phase II (weeks 2-8)

Appointments

• Rehabilitation appointments are 1-3 times per week

Rehabilitation Goals

  • Absolute control of external forces and protect graft

  • Nourish articular cartilage with motion

  • Decrease swelling

  • Prevent quad atrophy

Precautions

  • WB as tolerated, discontinue crutches

  • Avoid hyperextension

Suggested Therapeutic Exercise

Week 2

  • Continue previous exercises

  • Multi-angle isometrics

  • Mini-squats 0-40 degrees

  • Lunges

  • Leg Press 0-60 degrees

  • ROM 0-105

  • Proprioception training

  • Well leg exercises

  • PRE with 1 pound progression per week Week 4

  • ROM 0-125 degrees

  • Bicycle for ROM stimulus and endurance

  • Aquatic program if available

  • Eccentric quad 40-100 (isotonic only)

  • Closed kinetic chain exercise

    Week 6

  • Light hamstring curls

  • ROM 0-125 degrees

  • Increase aquatic program if available

    Week 8

  • Increase PRE exercise program

Cardiovascular exercise

  • Upper body circuit training or UBE

  • Week 4: Stair climber, elliptical

Progression Criteria

  • Normal gait on level surface

  • Good leg control without extensor lag, pain, or apprehension

 

Phase III (10-16 weeks post-operatively)

Appointments

• Rehabilitation appointments are once every 1-2 weeks

Rehabilitation Goals

  • Maximal strengthening for quads/lower extremity

  • Protect patellofemoral joint

Precautions

  • Avoid impact activities

  • Continue to protect graft

  • Protect patellofemoral joint

Suggested Therapeutic exercises

Week 10

  • All previous exercises

  • Lateral step ups

  • Calf raises

  • Wall squats

  • Lunges

  • Pool running

  • Continue PRE with no weight restrictions

    Week 12

  • All previous exercises

  • Isokinetic test (180/300 degrees per second 10-15 rep)

Cardiovascular exercise

• Aqua jogging, stair master, bicycle, UBE

Criteria for Progression

  • Dynamic neuromuscular control with multi-plane activities without pain or swelling

  • ROM 0-125 degrees

  • Quad strength 70% of contralateral side, knee flexor extensor

    rated 70-79%

  • Minimal effusion

  • Satisfactory clinic exam

 

Phase IV (4-5 months)

Appointments

  • Rehabilitation appointments are once every week

Rehabilitation Goals

  • Development of strength, power, and endurance

  • Begin gradual return to functional activities

Precautions

• No active reactive swelling or joint pain that lasts more than 12 hours

Suggested Therapeutic exercises

  • All previous exercises as appropriate

  • Eccentric quad work

  • Initiate plyometric program

  • Initiate running program

  • Sport specific training and drills

  • High speed isokinetic training

  • Isokinetic testing 180/300 degrees/second 10/15 reps

Cardiovascular exercise

Criteria for running

  • Isokinetic test 85 % of opposite quad; 90% opposite hamstring

  • Isokinetic test- quad torque/body weight 60% males and 50%

    females

  • No pain/swelling

  • Satisfactory clinical exam

    Functional drills:

  • Straight line running

  • Jog to run

  • Walk to run

Progression/ return to sport

  • Dynamic neuromuscular control with multi-plane activities, without pain, instability or swelling

  • Physician and rehabilitation specialist approval

 

Phase V (6-7 months)

Appointments

• Rehabilitation appointments are once every week

Rehabilitation Goals

  • Achieve maximal strength and endurance

  • Return to sport/work activities

Precautions

• No active reactive swelling or joint pain that lasts more than 12 hours

Suggested Therapeutic exercises

Quads:

  • Knee extensions

  • Wall squats

  • Leg press

  • Step-ups

    Strength

  • Hamstring curls

  • Calf raises

  • Hip abduction

  • Hip adduction

    Stability

  • High speed hamstrings

  • High speed hip flexion/extension

  • Balance drills

  • Backwards running

Cardiovascular exercise

  • Bicycle

  • Stair climber/elliptical

  • running

  • Swimming

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6 MONTH FOLLOW-UP

Isokinetic test if available

Functional test

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12 MONTH FOLLOW-UP

Isokinetic test if available

Functional test

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