ACL Part 2 Weeks 1-12

During the first 12 weeks following ACL repair when starting in Physical Therapy, exercises will be introduced based on several different factors:

1. The type of graft being used
2. Precautions given by MD
3. Patient pain level 
4. Activity tolerance

Exercises are to be individualized meaning, if you have a low tolerance or if your strength is not the same as someone else with the same type of repair, your exercises should be different.

Let me remind you that patellar tendon grafts cannot bend the knee past 90 degrees for the first 6 weeks. But unless otherwise stated by the surgeon, there is not a limitation for bending for other grafts.

Exercises 1-6 weeks

Quadriceps activation is arguably the most important factor when it comes to rehab in the first 6 weeks. So many of the exercises will focus on the quadriceps.

If not allowed to bend the knee more than 90 degrees:

• Quad sets

• SLR

• Side lying Hip abduction 

• Side lying hip Adduction

• Knee extension stretch

• Hamstring stretch

• Heel slides to 90 degrees

These exercises are also if you cannot bear weight through your leg following surgery. They will improve ROM and promote muscle activation of the leg.

If allowed to bend knee and bear weight:

• Same as above plus:
• Heel slides as far as tolerated

• SLS to improve WB on the leg

• Bike to increase ROM
• Sit to stands (which is a stepping stone to squats)

• Hurdles to improve gait pattern

Manual: PROM up to 90 degrees for patellar tendon grafts or more if another graft. This is performed by the PT. If this is nothing performed, seek out a different PT.

Exercises 6-12 weeks

Weight bearing exercises 

• Squats

• Step ups (improves knee stability)
• Step downs
• LAQ

• Leg press
• TKE
• Hamstring curls 

The introduction of the Long Arc Quad (LAQ) or Open kinetic chain knee extension exercises (check out my blog here on open and closed kinetic chain) is widely debated. But new research has found that it is alright to complete with low weight earlier on in the rehab process (https://pubmed.ncbi.nlm.nih.gov/17219226/). LAQ’s can be added earlier because the strain put on the ACL is less than even walking. 

Because of this research, I will begin unresisted LAQ at 6 weeks progressing to resisted as tolerate through the next few weeks. Other parameters I will consider are if there is still extension lag during the LAQ. If the patient is unable to completely straighten the knee, I will not give resistance.

The exercises listed above are just a few of the ones I will begin with at these stages of the rehabilitation process.