Post-Operative Accelerated Anterior Cruciate Ligament Repair Rehabilitation Protocols (Weeks 5-8)

Weeks 5-8 of post-operative Anterior Cruciate Ligament (ACL) repair will be difficult weeks of post-op. At the beginning of the fifth week of post-op, the patient’s flexion should be improved to 115°.¹ The athlete should progress to a stepper machine, which simulates the motion of climbing stairs, and be able to perform wall squats to a comfortable level. ¹ The athlete can also perform the exercises listed below, as long as no increased pain or edema occurs. ¹

Lunges4

^·          lunges

^·          lateral step ups onto an elevated platform

^·          forward step ups also onto a platform

Side Steps5

These exercises can be done in both sets and repetitions (reps), such as 3 sets of 15 reps, or they can be timed, continuous reps for 1-3 minutes. If the athlete has the feeling of increased laxity, decrease the amount of activity. ¹ Finally continue with ultrasound, cryotherapy (cold therapy), and electrical stimulation (E-stim) for pain control. Ultrasound can be used as a thermal effect or as a stimulus of tissue repair, depending on the application.³ When applying to a post-op athlete, ultrasound's thermal effect will be used to break up the scar tissue and assist in increasing structural elasticity for manual manipulation.³ The stimulus affect will increase blood flow, which aids in tissue healing.³

During weeks 6-8, the athlete should be progressed. If the athlete is at 115-120° of flexion and has full extension and no evidence of swelling or increase in pain occurs, the athlete should work on ambulation without a brace. ¹  The athlete should begin strengthening exercises as soon as they have full flexion.² The athlete can be progressed into a treadmill walking program, utilizing the incline setting at 12% or more to activate the quadriceps muscle group but limit stress on the ACL and patella. ¹ As the weeks go by, continue to progress the athlete in weight, sets, and repetitions. ¹

¹ Houglum, P. (2010). Therapeutic exercise for musculoskeletal injuries. (3 ed., pp. 890-891). Greensboro: Human Kinetics.

²Shelbourne, D., & Klotz, C. (2006). What i have learned about the acl: utilizing a progressive rehabilitation scheme to achieve total knee symmetry after anterior cruciate ligament reconstruction. Journal of Orthopedic Science, 11, 318-325. doi: DOI 10.1007/s00776-006-1007-z

³http://www.sportsinjuryclinic.net/treatments-therapies/electrotherapy/ultrasound-therapy

⁴http://www.medicinenet.com/butt_exercise_pictures_slideshow/article.htm

⁵http://exercise.about.com/library/blkneepainexercises.htm