Table 2.

Proposed Eccentric Training Implementation during Post-operative Isolated Unilateral ACL Rehabilitation Program (based on syudies by gerber et al. 2006, 2007, 2009, and Mikkelsen et al. 2000)

Phase	Description	Intensity (Rate of Perceived Exertion)
Phase I (Weeks 0-3)	Level I: CKC: Initiation of non-involved leg eccentric training for contralateral effect as early as day 2 post-operative unless restrictions or contraindicated.	Level I: Somewhat hard
Phase II (Weeks 3-12)	Level I: CKC: Initiation of eccentric training on total gym at lowest level. Subject lowers themselves down in limited ROM (initially 0-40°) with surgery leg and raises themselves back up to full knee extension with assistance from non-involved leg. ROM (to 90°) and resistance level is progressively increased dependent on patient tolerance and ability.	Level I: progressed from very light-fairly light-somewhat hard-hard
	Level II: OKC: Approximately 6 weeks post-operatively strengthening initiated from 90° - 45° flexion either isokinetically with low resistance (30°- 90°/sec) or light weight (at mid shin) and repetitions in the range of 20-30.	Level II: progressed from very, very light-fairly light-somewhat hard-hard if tolerated
Phase III (Weeks 12+)	CKC: leg press-resistance of moderate level (single leg): eccentric lowering with involved leg, followed by concentric knee straightening with non-involved leg. ROM should be in short range to start (0-30°) and systematically increased no greater than 90°. Smith frame squat rack-bilateral squats with eccentric emphasis on involved leg and concentric phase assistance by non-involved leg as with leg press. Smith frame-reverse lunges can be initiated here if patient tolerates. Eccentric phase with involved leg; patient then locks bar into frame, and bar is raised to starting position using both legs. Level I: CKC: leg press-moderate to heavy level resistance with technique as in phase II. ROM should be 0-90° unless otherwise contraindicated or not tolerated. Squat rack-bilateral squats as done in Smith frame in phase II.	Level I: progressed from somewhat hard to hard as tolerated.
	OKC: Eccentric isokinetic training at speeds of 30°-240° or with weight (at mid shin) with high repetition range (30-60).
	Level II: CKC: Squat rack-single leg lunges and reverse lunges progressed in intensity and ROM to 90° if not already achieved (Smith frame squat rack only if necessary)-eccentric emphasis only.	Level II: progressed from somewhat hard to hard as tolerated.
	Squat rack-single leg squats as done with bilateral squats in Level I.