Table 1.

Postoperative Phase 1: The Royal Dutch Society for Physical Therapy Evidence Statement for Anterior Cruciate Ligament Reconstruction Rehabilitation³

Goal Phase 1:“minimal synovitis/effusion, extension 0°, voluntary quadriceps control, active dynamic gait pattern”
Level of Body Functions and Structures
Mobility	Strength Training
Active and/or passive knee extension exercises when there is an extension deficit. Aim at an extension of 0° in 2 to 4 weeks.	Reactivation of the quadriceps: active knee extensions when seated with the legs straightened.
	Progress from isometric quadriceps exercise to concentric and eccentric exercises provided that the knee does not react with increasing temperature, effusion, and/or pain.
Heel slides to improve knee flexion. Aim at 120–130° of flexion in 4 to 6 weeks.	Closed kinetic chain quadriceps training (ROM 0-60°).
	Open kinetic chain quadriceps exercises can be performed without resistance from week 4 in ROM 90–45°. Increase ROM by 10° each week.
	Concentric and eccentric strength training of the gluteal muscles, hamstrings, and calf muscles
Level of Activities and Participation
Walking and Bicycling	Neuromuscular Training
Load the operated leg. Practice gait at different speeds and on various surfaces	Neuromuscular training on two legs. Gradually increase difficulty by adding perturbation; training on one leg; training on an increasingly difficult board; training with eyes closed; and adding tasks, such as catching and throwing a ball or answering a difficult arithmetical problem.
Start cycling on a home trainer when knee flexion reaches 100°. Use cycling as a warm-up and mobilization exercise.	Encourage correct quality of performance during strength training and walking.
Criteria to Start Phase 2:
Knee extension of at least 0° and 120–130° flexion.
Voluntary control of the quadriceps.
Active dynamic gait pattern without crutches.
Correct qualitative performance of phase 1 exercises.

Abbreviation: ROM, range of motion.

Reproduced from Br J Sports Med, van Melick N, van Cingel RE, Brooijmans F, et al. 50 (24), 1506–1515, 2016, with permission from BMJ Publishing Group Ltd.