GALLAND/KIRBY ACL RECONSTRUCTION: BONE-TENDON

1

GALLAND/KIRBY ACL RECONSTRUCTION: BONE-TENDON-

BONE AUTO / ALLOGRAFT POST-SURGICAL

REHABILITATION PROTOCOL

POST-OP DAYS 1 – 14

• Dressing:

– POD 1: Debulk dressing, TED Hose in place

– POD 2: Change dressing, keep wound covered, continue TED Hose

– POD 7-10: Sutures out, D/C TED Hose when effusion resolved

• Brace x 4 weeks – Locked in extension for ambulation

– Open to available range when pt has good quad control (no extensor lag)

• Crutches – weight bearing as tolerated (WBAT) in brace (D/C when gait is normal –

generally at 2 weeks)

• Patellar mobilization (teach patient)

• Calf pumping

• AAROM 0-90 degrees (passive extension, active flexion, heel slides)

• Passive extension with heel on bolster or prone hangs

• Electrical stimulation in full extension with quad sets and SLR

• Quad sets, Co-contractions quads / Hamstring

• Straight leg raise (SLR) x 4 on mat (in brace if poor quad control)

• Mini squats – 0-45 degrees in parallel bars

• Weight shifts

• Total Gym (level 3-5) – Mini squats 0-45 degrees

– Passive flexion to 90 degrees max (push up with opposite leg)

• Leg press 0-45 degrees with light resistance (up to ¼ body weight)

• Hamstring curls – Carpet drags or rolling stool (closed chain)

• Double leg heel raises

• Parallel bar ambulation – Forwards / backwards / lateral

• Stationary bike for ROM – Complete cycle as able

• Ice Pack with knee in full extension after exercise

GOALS

• Full passive extension

2

• Flexion to 90 degrees

• Good quad control

Weeks 2 - 4

• Brace x 4 weeks – Open to available range

• Crutches – WBAT, D/C when gait is WNL

• Continue appropriate previous exercises and following ex without brace

• Scar massage when incision healed

• AAROM, AROM through full range as tolerated

• Electrical stimulation – Continue as needed

• SLR x 4 on mat – Add light ankle weights if quad control is maintained

• Wall squats – No knee flexion past 45 degrees

• Total Gym – Progress levels of Mini-squats, 0-45 degrees

• Leg Press 0-45 degrees with resistance no more than ½ body weight

• Hamstring curls on weight machine with light resistance

• Forward, lateral and retro step downs in parallel bars

– No knee flexion past 45 degrees (small step)

• Single leg heel raises

• Proprioceptive training – Single leg standing in parallel bars

– Double leg BAPS for weight shift

• Stationary bike – Progressive resistance and time

• Treadmill – Forwards and backwards walking

• Stretches – Hamstring, Hip Flexors, ITB

GOALS

• ROM 0-110 degrees

• No effusion

• No extensor lag

WEEKS 4 - 6

• D/C Brace

• Continue appropriate previous exercises

• PROM, AAROM, AROM to regain full motion

• Standing SLR x 4 with Theraband bilaterally

• Mini squats, Wall squats 0-60 degrees – Progress to single leg

• Leg press 0-60 degrees with resistance no more than ½ body weight

• Forward, lateral and retro step downs 0-60 degrees (medium step)

3

• Proprioceptive training – Single leg BAPS, ball toss and body blade

• Elliptical trainer

• Pool therapy – Walking / running (no kicking)

GOALS

• Full ROM

• Normal gait

WEEKS 6 - 9

• Continue appropriate previous exercises

• Wall squats 0-90 degrees

• Leg press 0-90 degrees with resistance as tolerated

• Hamstring curls with resistance as tolerated

• Forward, lateral and retro step downs 0-90 degrees (large step)

• Hip weight machine x 4 bilaterally

• Proprioceptive training – Grid exercises

• Stationary bike – 15-20 minutes at a time, at least 70 rpm

• Treadmill – Walking progression program

GOAL

• Walk 2 miles at 15 min/mile pace

WEEKS 9 - 12

• Continue appropriate previous exercises with progressive resistance

• Fitter

• Slide board

• Functional activities – Figure 8s, gentle loops, large zigzags

• Stairmaster – Small steps

• Pool therapy – No swimming laps

• Quad stretches

GOAL

• Walk 3 miles at 15 min/mile pace

MONTHS 3 - 4

• Isokinetic testing at 180 and 300 degrees/sec – Must have 80%

• of opposite leg to clear for straight line running

• Continue appropriate previous exercises

• Knee extension weight machine

4

• Short arc quads

• Agility drills / Plyometrics

• Treadmill – Running progression program if cleared

• Pool therapy – Swimming laps

GOAL

• Run 2 miles at easy pace

MONTHS 4 - 6

• Repeat Isokinetic testing as needed

• Continue appropriate previous exercises

• Sit-up progression

• Running progression to track

• Transition to home / gym program

GOAL

• Return to all activities

*NO CONTACT SPORTS UNTIL 6 MONTHS POST-OP*

DEVELOPED BY: ADAPTED FROM:

Mark Galland, MD Physical Therapy Section

Kenneth Kirby, PT, DPT William Beaumont Army Medical Center

5

KNEE POST-OP PHASE I

Perform exercises below frequently: 30 reps, 3 – 5x a day