Principles of postoperative anterior cruciate ligament rehabilitation

Table 1 Goals of 0-1 mo (acute phase)

Education of patient

Pain control

Decrease effusion

Increase range of motion

Be able to do straight leg raise (1–2 d1)

Be able to lift the leg in all directions without assistance (1–7 d)

Flexibility (hamstrings, calves)

Strengthening (quadriceps, hamstrings, hip, calf, core, upper body, non- injured leg)

Patellar mobilization

Proprioceptive/balance training (start walking with crutches)

Start cardiovascular fitness (arm ergometer)

Achieve and maintain near or full ROM in knee flexion and extension (full extension 1–5 d1, full flexion 2-3 wk1)

Achieve and maintain weight bearing gait (2 crutches 0-1 wk1,

1 crutch 0-1 wk1, no crutches 0-2 wk1)

No apprehension when walking without a crutch

Home training program (2-3 h/d1, therabands, ROM exercises, etc.)

Start bicycling (90°-100° in active flexion1)

Start pool exercises (after suture removal, when wound is closed1)

Start to fight with fear of re-injury physically and psychologically

Return to work (3-4 wk1 if office work)

MD visit 1/wk

¹Author’s approach.

Table 2 Goals of 1-4 mo (maintenance and acceleration phase)

Decrease and disappearance of effusion

Full and pain-free knee range of motion

Continue flexibility exercises

Continue strengthening exercises (add isokinetic hamstring exercises)

Swimming

Bicycling (indoor)

Core training progression

Proprioceptive progression (focus on weak positions)

Maintain cardiovascular fitness

Determine and manage hamstring, quadriceps strength deficits

Prepare physically and psychologically for jogging

Deep water running

MD visit 2/mo

Table 3 Goals of 4-6 mo (sports-specific phase)

No effusion

Pain free jogging and running (no effusion)

Pain free landing (from double to single leg)

Pain free hopping (from double to single leg)

Functional strengthening (plyometrics, agility drills, etc.)

Sports specific proprioception training

Sport specific cardiovascular fitness

Training in the sports field

Adequate neuromuscular control

Continue fighting against fear of re-injury

Success in functional tests

MD visit 1/mo

Table 4 Month 4-6 (return to sports phase)

Flawless running

Good psychology

Maintain good results of functional tests

Adequate sports specific aerobic/anaerobic measures

Quadriceps and hamstring strength at least 85% of the normal leg

No swelling

No laxity

No fear