Table 2.

Phases 4 and 5 of the post-ACLR rehabilitation programme

Phase	Movement exercises	Gait exercises	Manipulative massage	Rehabilitation goals	Precautions
Phase 4 (4–8 weeks)	Fixed cycling training: gradually increasing the resistance. Squat training: Transition from double leg to single leg (0°−60°), gradually increasing resistance. Lunge training (0°−60°). Step training: centripetal and centrifugal contraction of the anterior thigh muscles (knee does not exceed 60°). Tiptoe training: Transition from double leg to single leg. Swing exercise: Standing using the affected leg, and the healthy leg is strapped with an elastic band and swings, transitioning from front-to-back swing to lateral swing and then to rotation or random direction movement. Rotational stability training: static lunge stance, lateral pull pulley exercise. Exercise with a rope tied around the waist to provide resistance; walking exercises in forward and backward, left and right directions. Walking exercises on the treadmill in four directions. Balance board training: various support surfaces, double-legged standing. Single-leg stand for ball tossing exercises. Core training: supine or prone position for bridge exercise, standing to pull the pulley.	Go around the obstacles at normal walking speed on different surfaces.	Manual method to loosen surgical scars.	Centre of gravity in the middle, squatting bilaterally to 60° (no more than 60°). Knee in good condition (slight pain and effusion, no instability). The circumference at the upper edge of the patella is 10 cm, with a 1–2 cm difference between the legs. The affected limb can maintain balance for>30 s while standing on one leg with little body sway.	No participation in sports which have a high impact on the joints, such as running or jumping. No participation in sports with high lateral stress on the joints. Avoid squatting deeply (limited to 0°−60°).
Phase 5 (8–12 weeks)	Squat training: transition from double to single leg (0°−60°), gradually increasing resistance. Lunge training (0°−60°). Tiptoe training: Transition from double-leg to single-leg. Increasing the strength of the posterior lateral muscle group with plyometric training. Core muscle strength training. ① Combined strength and balance training (throwing and catching balls on the balance board, and small squats on the balance board) ② Advanced balance function training (affected leg standing on one leg, hand or opposite foot to touch objects on the ground or lateral pulling elastic band) ③ Swimming training, in addition to breaststroke. Additionally, care should be taken not to stir the leg at a deep squatting angle or to use a splint when swimming. ④ Cycling training every other day.	——	——	The thigh circumference of both legs is approximately the same (within 1 cm of each other). The affected limb squats to 60° on one leg. The affected limb can stand on one leg to maintain balance for 60 s. Little, if any, oedema with activity.	Patellar tendonitis may occur.

ACLR, anterior cruciate ligament reconstruction.