Intended for licensed physical therapists coordinating care with Dr. Vasileff. Defer to the operative note and the surgeon’s office for patient-specific direction.

Knee · Ligament

ACL Reconstruction + Meniscal Repair

Post-operative protocol · Dr. Chris Vasileff, MD

For the treating physical therapist. This protocol is a guideline; progression is criteria-based and individualized. Defer to the operative note and the surgeon’s office for patient-specific direction.

ACL Recon & Meniscal Repair Rehabilitation Protocol

**If large meniscus repair with ACL, the following changes are necessary**

Weight Bearing- PWB (50%) for 4 weeks.

Brace- brace locked 0/0 for 4 weeks

ROM- 0-50° for 3 weeks; advance gradually to 90° afterwards

Phase I – Maximum Protection (Weeks 0 to 4):

Weeks 0 to 2:

Ice and modalities to reduce pain and inflammation
Elevate the knee above the heart for 3 to 5 days
PWB (50%) for 7-10 days in brace than WBAT with crutches to reduce swelling. The patient may wean off crutches (patient still in brace) when they can ambulate without a limp.
Brace locked in full extension for 4 to 6 weeks per physician orders
Initiate patella mobility drills
Begin passive/active knee range of motion to 90° of knee flexion and strong emphasis on full knee extension
Quadriceps setting focusing on VMO contraction
Blood Flow Restriction Therapy for muscle mass and quad activation
Multi-plane open kinetic chain straight leg raising
Gait training

Weeks 2 to 4:

Begin open and closed kinetic chain resisted cord multi-plane hip strengthening as acute inflammation resolves
Proprioception training
Manual PNF hip and ankle patterns
Begin pool program when incision sites healed (~ week 3)

Phase II – Progressive Stretching and Early Strengthening (Week 4 to 6):

Weeks 4 to 6:

Gradually restore full range of motion with emphasis on extension/hyperextension
Continue with ice and modalities as needed
Normalize gait
Open brace to 0° to 90° per physician’s orders
Initiate lower extremity stretching program
Begin stationary bike, treadmill, and/or elliptical trainer as strength and swelling allow
Begin closed kinetic chain strengthening progressing from bilateral to unilateral as tolerated
Implement reintegration exercises emphasizing core stability
Advance closed kinetic chain multi-plane hip strengthening
Proprioceptive drills emphasizing neuromuscular control

Phase III – Advanced Strengthening and Proprioception Phase (Weeks 6 to 12):

Weeks 6 to 10:

Modalities as needed to control swelling
Wean out of brace weeks 6 to 8
Advance time and intensity on cardiovascular program - no running
Begin functional cord program

Weeks 10 to 12:

Initiate gym-strengthening program – Progressing form bilateral to unilateral

Leg press, squats, lunges, hamstring curls, ab/adduction, calf raises, and leg extensions (0° to 30°)

May begin outdoor biking and conservative hiking

Phase IV – Strengthening and Plyometric Phase (Weeks 12 to 20):

Weeks 12 to 20:

Implement a full gym-strengthening program
Begin pool running progressing to dry land as tolerated
Advance proprioception and begin plyometrics progressing from bilateral to unilateral as tolerated
**Pass sport cord test around 5 months to allow advanced agility progression to begin**

Phase V – Return to Sport Functional Program (Week 20 to 24):

Follow-up examination with physician
Implement sport specific multi-directional drills
Implement interval functional program per physician approval
Continue with aggressive lower extremity stretching, strengthening, and cardiovascular training
Advance plyometric program as tolerated
Sports test for return to play

RETURN TO ACTIVITIES

Running: 3-4 months when functional criteria are met

Golf: Short irons at 4 months, full swing with long irons at 5 months.

Delay 4-6 weeks if lead leg.

Pivoting/cutting sport: When functional criteria are met and cleared by surgeon, typically

6 months at earliest

Questions about a protocol? Contact Dr. Vasileff’s office at (704) 865-0077.