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Dr. Vonda Wright MD

Orthopedic Surgeon

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ACL Allograft Reconstruction Rehab Protocol

GENERAL GUIDELINES

  • Allograft revascularization is slower than for autografts. Therefore, crutches and brace are continued for 6 weeks
  • CPM not commonly used
  • ACL reconstructions performed with meniscal repair or transplant follow the ACL protocol with avoidance of open kinetic chain hamstring work for 6 weeks. Time frames for use of brace and crutches may be extended by the physician

GENERAL PROGRESSION OF ACTIVITIES OF DAILY LIVING

Patients may begin the following activities at the dates indicated (unless otherwise specified by the physician):

  • Bathing /showering without brace after suture removal
  • Sleep with brace locked in extension for 1 week
  • Driving: 1 week for automatic cars, left leg surgery, 4-6 weeks for standard cars or right leg surgery
  • Brace locked in extension for 1 week for ambulation
  • Use of crutches, brace for ambulation for 4-6 weeks
  • Weight-bearing – PWB of 50%

PHYSICAL THERAPY ATTENDANCE

The following is an approximate schedule for supervised physical therapy visits:

Phase I (0-6 weeks): 1 visit / week
Phase II (4-6 weeks): 2-3 visits / week
Phase III (2–6 months): 2-3 visits / week
Phase IIII (6 months+): Discharge after completion of appropriate functional progression

REHABILITATION PROGRESSION

The following is a general guideline for progression of rehabilitation following ACL patellar tendon autograft reconstruction. Progression through each phase should take physician advisement. Please consult the physician if there is any uncertainty concerning advancement of a patient to the next phase of rehabilitation.

PHASE I

Begins immediately post-op through approximately 4 weeks

Goals:

  • Protect graft fixation
  • Minimize effects of immobilization
  • Control inflammation
  • Full extension range of motion
  • Educate patient on rehabilitation progression

Brace:

0-1 week:  locked in full extension for ambulation, sleeping
1-4 weeks: unlocked for ambulation, remove for sleeping

Weight-Bearing Status:

0-4 weeks: PWB (50%) with 2 crutches

Therapeutic Exercises:

  • Heel slides
  • Quad sets, hamstring sets (consider NMES for poor quad sets)
  • Patellar mobilization
  • Non-weight bearing gastroc/soles, hamstring stretches
  • SLR, all planes, with brace in full extension until quadriceps is sufficient to prevent extension lag
  • Quadriceps isometrics at 60º and 90º

PHASE II

Begins approximately 4 weeks post-op and extends to approximately 6 weeks

Criteria for advancement to Phase II:

  • Good quad set, SLR without extension lag
  • Approximately 90 degrees of flexion
  • Full extension
  • No signs of active inflammation

Goals:

  • Initiate closed chain kinetic exercises
  • Restore normal gait
  • Protect graft fixation

Brace / Weight-Bearing Status:

  • Discontinue use of brace and crutches as allowed by physician when the patient has full extension and can SLR without extension lag
  • Patient must exhibit non-antalgic gait pattern. Consider using single crutch or cane until gait is normalized

Therapeutic Exercises:

  • Wall slides 0-45 degrees progressing to mini squats
  • 4 way hip
  • Stationary bike (begin with high seat, low tension to promote ROM, progress to single leg)
  • Closed chain terminal extension with resistive tubing or weight machine
  • Toe raises
  • Balance exercises (e.g. single-leg balance, KAT)
  • Hamstring curls
  • Aquatic therapy with emphasis on normalization of gait
  • Continue hamstring stretches, progress to weight-bearing gastroc / soleus stretches

PHASE III

Begins at approximately 6 weeks and extends through approximately 6 months

Goals:

  • Full range of motion
  • Improve strength, endurance and proprioception of the lower extremity to prepare for functional activities
  • Avoid overstressing the graft fixation
  • Protect the patellofemoral joint

Therapeutic Exercises:

  • Continue and progress previous flexibility and strengthening activities
  • Stairmaster (begin with short steps and avoid hyperextension)
  • Nordic Track
  • Knee extensions 90-45 degrees and progress to eccentrics
  • Advance closed kinetic chain activities (leg press, one-leg mini squats 0-45 degrees of flexion, step-ups beginning at 2” and progress to 8, etc.)
  • Progress proprioception activities (slide board, use of ball, racquet with balance activities, etc.)
  • Progress aquatic program to include pool running, swimming (no breaststroke)

PHASE IV

Begins at approximately 6 months and extends through approximately 9 months

Criteria for advancement to Phase IV:

  • Full, pain free ROM
  • No evidence of patellofemoral joint irritation
  • Sufficient strength and proprioception to initiate functional activities
  • Physician clearance to initiate advanced closed kinetic chain exercises and functional progression

Goal:

  • Continue and progress previous flexibility and strengthening activities
  • Functional progression including:
  • Walking / job progression
  • Forward / backward running at ½, ¾ and full speed

PHASE V

Begins at approximately 9 months post-op

Criteria for advancement to Phase V:

  • No patellofemoral or soft tissue complaint
  • Necessary joint ROM, strength, endurance and proprioception to safely return to work or athletics
  • Physician clearance to resume partial or full activity

Goals:

  • Initiate cutting and jumping activities
  • Completion of appropriate functional progression
  • Maintenance of strength, endurance and proprioception
  • Patient education with regards to any possible limitations

Therapeutic Exercises:

  • Functional progression, including but not limited to:
  • Walk / job progression
  • Forward / backward running at ½, ¾ and full speed
  • Cutting, cross-over carioca, etc.
  • Plyometric activities as appropriate to patient’s goals
  • Sport-specific drills
  • Safe, gradual return to sports after successful completion of functional progression
  • Maintenance program for strength and endurance

Bracing:

Functional brace may be recommended by the physician for use during sports for the first 1-2 years after surgery

My Other Surgical Specialties

  • Shoulder Surgery
    • Rotator Cuff Repair
    • Subacromial Decompression (SAD) / Distal Clavicle Resection (DCR)
    • Shoulder Instability
  • Hip Surgery
    • Hip Arthroscopic Surgery
    • Rehab Protocols for Hip Surgery
  • Knee Surgery
    • Meniscus
    • ACL
    • MPFL

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About

Orthopaedic Surgeon, Author, Speaker and "The Mobility Doc," Dr. Vonda Wright is an internationally recognized authority on active aging and sports medicine.

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