Table A1.
Rehabilitation Program for ACL Reconstruction With Contralateral Patellar Tendon Graft
| Goals | Exercises |
|---|---|
| Preoperative | |
| ACL-reconstructed knee | |
| Reduce swelling | Cold/compression; elevation |
| Obtain full ROM | Hyperextension device/heel slides 3×/day |
| Good leg control | Active terminal extension |
| Achieve normal gait | Gait training |
| Mental preparedness | Patient education of program and goals |
| Graft-donor knee | |
| Maintain leg strength | Practice step-up exercise used postoperatively for graft knee |
| Surgery | |
| ACL-reconstructed knee | |
| Maintain full ROM | Passive motion from full hypertension to full flexion (heel touches buttocks) |
| Prevent pain and swelling | Intravenous ketorolac pain prevention program 54 |
| Graft-donor knee | |
| Bone graft the defects in the patella and tibia | — |
| Close patellar tendon defect | — |
| Phase 1 (immediate postoperative through 1 wk postoperative) | |
| ACL-reconstructed knee | |
| Minimize hemarthrosis | Cold/compression to remain on the knee except during exercises; elevation |
| Full passive hyperextension | Heel prop, 10 min, 4×/day |
| Flexion to 125° | CPM set at highest flexion possible; leave leg in maximal flexion for 3 min, 3×/day |
| Gentle ROM | Heel slides; use measuring stick to monitor progress |
| Independent leg raise | CPM machine set to move from 0° to 30° continually when not doing exercises; knee is elevated above the heart in the CPM machine |
| Weightbearing as tolerated | Active quadriceps contractions; straight-leg raises; active terminal extension |
| Normal gait | Gait training |
| Graft-donor knee | |
| Minimize swelling | Cold pack; leg elevated on pillow |
| Full passive hyperextension | Heel prop exercise to allow for full hyperextension |
| Full flexion | Heel slides; pull heel to buttocks; use measuring stick to monitor progress |
| Donor site strengthening | Shuttle machine; set resistance so able to do 25 repetitions, 3×/day; progressively increase repetitions and resistance |
| Phase 2 (1 wk through 1 mo postoperative) | |
| ACL-reconstructed knee | |
| Maintain full extension | Heel prop |
| Be able to lock knee straight with full weightbearing | Single-leg stance; locking knee in extension |
| Increase flexion equal to opposite knee | Heel slide |
| Maintain minimal swelling | Cold/compression |
| Normal gait | Gait training in front of a mirror |
| Progress to light strengthening | Active terminal extension; progress to stationary bicycling |
| Graft-donor knee | |
| Maintain full extension and flexion | Heel prop; heel slide |
| No swelling | Ice after exercise |
| Donor site strengthening | ▪ Shuttle exercise: up to 100 repetitions 3×/day (through 2 wk postoperative) ▪ Step-box exercise at height to allow for 50-100 repetitions; perform 3-4×/day ▪ Progress to single-leg weight training exercises (still high repetition/low resistance): leg press, leg extension |
| Phase 3 (after 1 mo postoperative as patient is able to progress) | |
| ACL-reconstructed knee | |
| Maintain full ROM | Heel props as needed; sit on heels |
| Control swelling | Cold/compression; adjust activities to keep swelling to a minimum |
| Quadriceps strengthening | Bicycle; Stairmaster; can progress to leg press, leg extension, squats once strength symmetry is within 10% |
| Return to light sports | Functional progression from agility drills, sport-specific agility drills, to controlled practice drills |
| Graft-donor knee | |
| Donor site strengthening | Single-leg strengthening; increase weight and decrease repetitions for weight training exercises; can progress to double-leg strengthening once symmetry is within 10% |
| Phase 4 (after 3 mo postoperative as patient is able to progress) | |
| ACL-reconstructed knee | |
| Maintain full ROM | Exercises as needed; watch for motion loss and decrease activities if needed; monitor daily |
| Control swelling | Adjust activities to keep swelling to a minimum; continue using cold/compression |
| Return to full sports | Continue sport-specific and controlled practice drills and progress first to part-time competition and then full-time competition |
| Graft-donor knee | |
| Return donor site functional strength | ▪ Continue with weight training 3-4×/wk ▪ Increase functional strength through sport-specific activities; alternate intensity with hard and easy days |
a ACL, anterior cruciate ligament; CPM, continuous passive motion; ROM, range of motion.