ACL and collateral ligament reconstruction

Post-op recovery	First 2 weeks	Date
Goals	Protect the knee and surgical incisions Recover from swelling and inflammation Control of post-surgical pain
Precautions	Fully weight-bear but use crutches for support and to improve gait
Brace	Locked in extension when mobilising Unlock brace at rest and when doing ROM exercises At rest the brace can be loosened to allow swelling and discomfort to settle Sleep in brace (locked in extension)
Recommendations	Rest and elevate as required Ice the knee up to 3 times a day – particularly in the first 72 hours Range of motion exercises of ankle Range of motion exercises of hip Gentle movement of the knee from full extension to 90 degrees of flexion as pain and swelling allows When walking with crutches – concentrate on achieving heel strike, role through and toe off When standing, push both knees back straight to help achieve full extension
Exercise suggestions	Static quads contraction Supine straight leg raise Ankle pumps Supine bed supported knee bend Sitting supported knee bend Sitting knee extension stretch – foot on floor Supine knee extension – foot elevated/supported Standing knee extension Side leg raise – knee straight in brace Double calf raises
Criteria for progression	Healed surgical incisions

Phase 1	Week 2 to week 6
Goals	Increase ROM Begin strengthening Normal gait Minimal Pain Minimal Swelling
Precautions	Keep using crutches and wearing brace
Brace	Locked in extension when mobilising Unlock brace at rest and when doing ROM exercises At rest the brace can be loosened to allow swelling and discomfort to settle Brace can come off to sleep
Recommendation	When standing, push knees back straight to help achieve full extension When walking – concentrate on achieving heel strike, role through and toe off Increase range of motion from full extension to full flexion Hip and gluteal muscle strengthening No gluteal band exercises – protect collateral ligament repair Ankle range of motion and strengthening
Exercise suggestions	Low load, long duration (assisted as required) Wall slide mini squat Double leg squats (0-60) Sitting unsupported knee extension and flexion Single leg stance – knee straight, knee flexed Straight leg raise Step ups Double calf raises – progress to single calf raise Side leg raise – knee straight in brace No gluteal band exercises – protect collateral ligament Bridging with gluteal contraction Exercycle – low resistance, short interval Cardio: Swimming (freestyle or backstroke only), Hydrotherapy, Stationary bike cycling, Upper body weight training (must be seated or lying)
Criteria for progression	No active extension lag, 110º active flexion Minimal effusion/pain Normal Gait Functional strength and control in daily activities

Phase 2	Week 7 to week 12
Goals	Gain full range of motion Muscle strengthening Neuromuscular control No swelling No pain
Precautions	Wean off crutches as soon as able No running until week 12 if meeting all criteria
Brace	Fully unlock brace at all times Brace worn only for mobilising Brace can be discarded after week 8
Recommendations	Fully weight bear as able Passive stretching to achieve full extension and flexion Concentrated full rehab program that includes strengthening of core, hip flexors, gluteal muscles, external rotators of the hip, quadriceps, hamstrings and calves. Neuromuscular control and co-ordination of leg
Suggested exercises	Double leg squats (0-90) Single leg squats Single leg hop Step ups – increase height Step downs Resisted quads and hamstring weight training Gluteal band exercises Bridging with gluteal contraction Double calf raises – progress to single calf raise Exercycle – increase resistance and training length Neuromuscular Training: Wobble board, rocker board, roller board, Varied surfaces Cardiopulmonary: Bike, Elliptical trainer, Stairmaster, swimming
Criteria for progression	Walking 20 minutes without pain or swelling Neuromuscular and strength training exercises without difficulty Full ROM

Phase 3	3 Months – 6 months
Goals	Running on flat surface Jumping (double leg) Hop Tests 75% of contra-lateral side Hopping without pain, swelling, or giving way
Precautions	Run on flat stable surface in daylight No pivoting or cutting activities or sports
Recommendations	Passive stretching to achieve full extension and flexion Concentrated full rehab program that includes strengthening of core, hip flexors, gluteal muscles, external rotators of the hip, quadriceps, hamstrings and calves. Neuromuscular control and co-ordination of leg
Suggested exercises	Running on flat even surface. Gradually increasing distance Aggressive strength training Hamstrings, Quads, calves, adductors, abductors, core strength Cycling with high resistance (standing permitted) Neuromuscular Training: Wobble board, rocker board, roller board, varied surfaces Begin gentle pivoting and direction changing Cardio: Running, swimming, cycling,stair climber, elliptical trainer
Criteria for progression	Maximum vertical jump without pain or instability 75% of contralateral on hop tests Run at 75% speed without difficulty Some confidence with pivoting and changing direction

Phase 4	6 Months – 12 months
Goals	100% contralateral strength 85% contralateral on hop tests Running without pain Absolute confidence with pivoting and turning
Precautions	NO pivoting or contact sports Can return to non-competitive non-contact sport training
Recommendations	Gain and maintain endurance and strength Sport specific functional training Graduated return to cutting and pivoting movements Neuromuscular control and coordination
Suggested exercises	Running on flat even surface. Sprinting. Direction changes Aggressive strength training Hamstrings, Quads, calves, adductors, abductors, core strength Cycling with high resistance (standing permited) Hopping, jumping Pivoting and direction changes Begin cutting (non-competitive environment) Cardio: Running, swimming, cycling, stair climber, elliptical trainer
Criteria for progression	Return to sport criteria -One year post reconstruction -No functional complaints -Confidence when running, cutting, jumping at full speed -85% contralateral values on hop tests