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. 2023 Dec 19;13(12):e065254. doi: 10.1136/bmjopen-2022-065254

Table 1.

Phases 1–3 of the post-ACLR rehabilitation programme

Phase Movement exercises Gait exercises Manipulative massage Rehabilitation goals Precautions
Phase 1 (within 1 week)

  1. Placing the heel against the bed for flexion and extension sliding; supine position, the affected leg bends the hip, flexes the knee and places the heel on the wall for flexion and extension sliding; sitting position, legs on the floor; the healthy leg is placed in front of the affected leg and assists the affected leg in flexing the knee.

  2. Ankle pump exercises (the affected leg is elevated, and the foot performs upward hooking and downward stepping movements, along with rotational movements).

  3. Anterior thigh muscle tensing exercises with the knee in straight position (can be combined with neuromuscular electrical stimulation or biofeedback exercises).

  4. Hip muscle group training.

  5. Pillow clamping of the legs for medial thigh muscle group strength training.

  6. The brace is locked in 0° position, and the affected leg is lifted in the supine and prone positions for muscle strength training.

  7. Passive knee extension exercises: prone position with the affected knee extended out of bed for suspension or supine position with the affected leg in a slightly elevated heel position and the knee joint suspended.

  8. Weight transfer training (front-to-back and left-to-right) can be performed in the above mentioned weight-bearing exercise position.

  9. Continuous passive movement apparatus training with increased knee flexion by 5°–10°/day.

  1. Flat and step gait training with the support of a knee protection brace and double crutches.

  2. Cold compresses after training to reduce oedema.

  1. Pushing the patella in all directions.

  2. Manipulation of the posterior thigh muscles of the affected limb or sitting and standing to pull the muscles to relieve their spasm.

 Active mobility of the knee joint reaches 0°–90°. (1) The anterolateral thigh muscles can be tightened better. (2) The affected limb can be fully weight-bearing with the help of braces and crutches. (3) Oedema control is good. (4) Good wound healing.

  1. Brace locked in 0° position, crutches, and weight-bearing exercises within a tolerable range.

  2. Wearing the brace at night and locking it in 0° position while sleeping with the affected leg elevated.
Phase 2 (1–2 weeks)

  1. Fixed cycling exercises (from small to a full range of pedal rotation).

  2. Tightening and 90° muscle strength exercises for anterior thigh muscles in straight position.

  3. Standing balance training on the affected leg with a single leg wearing support.

  4. Balance training on a balance board with forward and backward weight transfer.

  5. Continuous passive activity equipment training.

  6. Starting small partial weight-bearing squat exercises (within 30° of knee flexion).

  7. Passive straightening exercises with the heel slightly elevated and the knee hanging in air.

  8. Straight leg raises training (all directions).

  9. Terminal angle knee extension training in the standing position using an elastic band.

  1. The healthy leg stands outside the treadmill with weight, and the affected leg simulates walking on the treadmill.

  2. The affected leg crosses the obstacle training and simulates walking.

  1. Manipulation to push the patella treatment.

  2. Manipulate of the posterior thigh muscle group for relaxation and stretching exercises.

 Active mobility of the knee joint reaches 0°−120°. (1) Straight leg elevation; anterior thigh muscles can be tightened with force. (2) The patient can walk normally using crutches with a nonlocking brace.

  1. Weight-bearing exercises within tolerable limits.

  2. Transition from double to single crutch.

  3. When the strength of the anterior thigh muscle group is well exercised, the locking brace can be gradually dispensed (the anterior thigh muscle group can be unlocked to more than 30° only when it can contract forcefully to keep the straight leg elevated).
Phase 3 (2–4 weeks)

  1. Fixed bicycle training gradually increases the resistance to improve exercise endurance.

  2. Tightening exercises for the anterior thigh muscle group in straight position and muscle strength exercises in the range of 60°−90° until the muscle strength of both legs is equal.

  3. 0°−60° squat training, gradually increasing the resistance strength (for patients with meniscal repair, squat to the target angle on the healthy leg before shifting the weight to the middle of the two legs).

  4. Stand with both legs on a balance board for balance training in multiple directions.

  5. Single-leg standing balance training on the affected leg (with eyes closed and open and on a support surface with different degrees of softness).

  6. Straight leg raise training in the standing position can increase resistance appropriately.

 Exercise with a rope tied around the waist or on a treadmill for forward and backward gait training.

  1. Manipulation to push the patella treatment.

  2. Manipulation of the surgical scar.

  3. Manipulative passive knee flexion or extension angle exercises.

 The knee joint moves to an active full angle, aligning with the healthy side leg. (1) Normal gait can be achieved without any walking aid. (2) Self-care in daily life (may have difficulty walking up and down steps). Fully weight bearing; normal gait can be achieved without a brace or walker at 3 weeks postoperatively.

ACLR, anterior cruciate ligament reconstruction.