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ACL RECONSTRUCTION FUNCTIONAL ACTIVITIES TIMELINE

Please be aware that this timeline is a guide only. Everybody’s degree of healing differs and you may progress faster or slower than indicated.

0-2 weeks:

Weight-bearing as tolerated. Begin walking with the use of the crutches, easing off them as your pain allows

Stationary bike riding as soon as able with no resistance. Begin doing only 10 minutes at a time, increasing the time to 20 minutes. Ice your knee before and after.

If your surgeon has asked you to wear a splint do not bike

See your physiotherapist at 2 weeks after your knee reconstruction.

2-6 weeks:

Begin an aquatic physiotherapy program designed for you by your physiotherapist.

Keep up with your rehab program as indicated by your physiotherapist.

Gently increase the resistance on the stationary bike as your pain allows.

6-12 weeks:

At 6 weeks begin swimming, use a pool buoy in between your legs and do not kick. This will start to improve your cardiovascular fitness and upper body strength.

At 10 weeks begin swimming with a light kick

Begin riding on the road at 8 weeks.

Start jogging only when you are cleared to do so by your surgeon. Generally, this will be between 12 and 16 weeks after your surgery.

12 weeks to 5 months:

Strength and agility exercises will progress

Low-impact step aerobics classes can be commenced as indicated by your physiotherapist.

Commence sport-specific activities guided by your physiotherapist.

5-6 months:

Return to training and participating in skill exercises.

Follow your physiotherapist’s guidelines for return to sport modifications.

Train in PEP program for warm-up to reduce further ACL injury.

ACL RECONSTRUCTION EXERCISES

(Exercises to be done 3 times per day)

Stage 1 (0-2 weeks):
Goals:

Control Swelling

  • REST.
  • ICE – 15 to 20 minutes, 4 times per day
  • COMPRESSION – Wear tubigrip during the day
  • ELEVATE – rest as frequently as you can with your leg up on a bed/couch

Mobility

  • Achieve correct gait, FWB (full weight bearing). If pain allows without crutches

Exercises

  • Achieve full passive extension (straighten out flat)
  • Achieve full flexion (bending of the knee) – may be limited by swelling
  • Active strengthening begins with static weight-bearing co-contractions of quadriceps and hamstrings (emphasising Vastus Medialis Oblique or VMO) and progresses to active free hamstring contractions by day 14.

Ankle Exercises

Move your foot up and down and around in circles. Repeat 10 times in Each direction every hour, for the first few days.

Hamstring Stretch

Keeping knee and back straight, lean forward until you feel a gentle stretch behind the knee. Hold for 20 seconds, relax, repeat 3 times.

Calf Stretch

Use a towel or belt around the foot to pull the toes towards the face. Hold for 20 seconds, relax, repeat 3 times.

Hamstring Stretch

Keeping knee and back straight, lean forward until you feel a gentle stretch behind the knee. Hold for 20 seconds, relax, repeat 3 times.

Quad Sets/Extension

  • Sit or lie on your back with your leg straight.
  • Press the back of your knee downwards by tightening the muscle on the front of your thigh.
  • Hold for 5 seconds.
  • Repeat 3 x 10 times

Isometric Quadriceps/Hamstring Co-Contraction (long sitting position)

  • Sit with a rolled-up towel under your knee and the thigh rolled outwards.
  • Dig your heel into the bed and tighten the whole thigh.
  • Place fingers on the inner thigh just above the kneecap to feel the quadriceps/vastus medialis muscle contracting.
  • Hold contraction for 5 seconds and rest for a few seconds.
  • Repeat 3 x 10 times.
  • You can also do this sitting

Bent Leg Raise

  • With the knee bent to about 30 degrees, lift the leg off the bed.
  • Keep your knee flexed at 30° throughout the exercise.
  • Hold for 5 seconds, then relax.
  • Repeat 3 x 10 times.

FLEXION EXERCISES

Passive Flexion in Sitting

Commence now.

  • Wrap a towel around the ball of your foot of your operated leg.
  • Holding the ends of the towel in your hands, gently pull the ends of the towel so that your knee bends with it.
  • Hold at the comfortable limit of flexion for 5 seconds.
  • Continue slowly 10 times. Gradually increase to 30 times.

Passive Flexion in Prone

Commence in 1-2 days.

  • Lie on your stomach.
  • Place the foot of the unoperated leg underneath the shin of the operated leg.
  • Gently assist the injured leg to bend as far as comfortable by pushing up with the unoperated leg.
  • Hold at the limit of flexion for 5 seconds.
  • Continue slowly for 10 to 30 times.
  • Continue to do passive flexion in sitting exercise before this one.

EXTENSION EXERCISES

Supine Hangs

Start now.

  • Lie or sit with your foot up on a rolled towel/ball/bolster.
  • Relax your knee in a straight position for 30 seconds.
  • Continue for a total of 5 minutes.

Prone Hangs

Begin in 1-2 days. * Only do this extension exercise. Stop doing the Supine Hangs*

  • Lie on your stomach with the kneecaps over the edge of a firm bench or bed.
  • Let the operated knee gently hang over the end of the bench/bed.
  • Hang for 1 minute, lift slightly up with the good leg to rest for 30 seconds.
  • Continue for a total of 5 minutes.

Advanced Prone Hangs

Begin in 5-7 days. * Only do this extension exercise. Stop doing the Prone Hangs*

  • Lie on your stomach with kneecaps over the edge of the bench or bed.
  • Let the operated knee gently hang over the end of the bed/bench.
  • Rest the foot of your good leg over the ankle of your operated leg, to gain a greater stretch.
  • Hold the position for 1 minute, then ease the pressure off by lifting the good leg off for 30 seconds.
  • Continue for a total of 5 minutes.

Patella Mobilisation

With the knee extended, move the kneecap gently up and down as well as side to side.