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

ACL 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.

Phase I – Maximum Protection (Weeks 0-2):

Week 0-1:

  • Brace locked at 0-0 for 6 weeks
  • Brace at all times when not exercising, for six weeks
  • Ice and modalities to reduce pain and inflammation
  • Non WTB for first 2 weeks

Range of Motion

- Begin aggressive patellar mobility

- Emphasize full extension

- ROM 0-0 for 1st week

Exercises

- Quadriceps setting, focusing on VMO

- Multi-plane straight leg raising

- Blood Flow Restriction to maintain muscle mass & activate quad

- Gait training

Weeks 1-2:

  • Continue with program outlined above:

Range of Motion

- Full knee extension/hyperextension

- ROM 0-90 deg Passive only

Phase II – Progressive Stretching & Early Strengthening (Weeks 2-6):

Weeks 2-4:

  • Toe touch PWB for 4 weeks
  • Continue with modalities to control inflammation

Range of Motion

- Full knee extension/hyperextension

- Knee flexion to 120°, progress as tolerated

Exercises

- Continue with phase I exercise

- Bilateral closed kinetic chain squatting

- Multi-plane open and closed kinetic chain hip strengthening

- Blood Flow Restriction to maintain muscle mass & activate quad

- Step-up progression

Weeks 4-6:

Range of Motion

  • Full knee flexion and extension

Exercises

- Advance strengthening program progressing to unilateral as tolerated

- start stationary bike program, + slowly and increase intensity

- Advance intensity of pool program; focus on strengthening

Phase III – Adv Strengthening & Proprioception Phase (Weeks 6-10):

Weeks 6 to 10:

Range of Motion

- Brace 0/90 deg, for next 2 weeks then d/c brace

- Advance to Full knee flexion and extension with terminal stretch

Exercises

- Advance intensity of cardiovascular program; no running

- add treadmill walk at week 8

- Stationary biking

- Pool program when incisions healed; focus on ROM

- Increase intensity of closed kinetic chain exercises

- Advance proprioception drills at week 8

- Initiate gym strengthening progressing from bilateral to unilateral as tolerated Leg press, squats, partial lunges, hamstring curls, ab/adduction, calf raises

- Begin multi-directional functional cord work; no carioca

- May begin a pool running program at week 12

Phase IV – Advance Strengthening and Plyometric Drill Phase (Weeks 10 to 16):

Weeks 10 to16:

  • Brace d/c week 10
  • Implement a full gym strengthening program; including leg extensions at 30° - 0°, progressing to full range as PF arthrokinematics normalize
  • Begin straight plane running
  • Begin non-aggressive plyometric drills

Phase V – Return to Sport and Functional Drills Phase (Weeks 16-20):

Weeks 16-20:

  • Continue with aggressive lower extremity strengthening, cardiovascular training, and flexibility
  • Implement sport specific drills; multiplane
  • Advance plyometric drills from bilateral to unilateral as tolerated
  • Blood Flow Restriction Therapy to build muscle mass
  • Follow-up examination with the physician
  • Brace fitting for functional knee brace if desired
  • Sports test for return to competition (Vail Sport Cord Test)
Questions about a protocol? Contact Dr. Vasileff’s office at (704) 865-0077.