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ACLR Rehabilitation Therapist information

My Protocol for Physio and Rehab Regime

Outpatient Physiotherapy

Patient should be seen by physiotherapist 1 week post surgery

Week 1:  


  • Eliminate swelling/inflammation
  • Adequate analgesia 
  • Regain active quads and VMO control
  • Be able to perform SLR with no lag
  • Restore patella mobility 
  • Maintain full hyperextension 
  • Restore normal gait pattern 
  • At least 90 degrees knee flexion 
  • Patient confident with rehab process and goals


  • Patient education regarding rehabilitation 
  • Patella mobilisations 
  • Maintain 0-90 ROM 
  • Quad strengthening- Closed chain- mini squats 
  • Hamstring/ glut strengthening- Closed chain- Shoulder bridges (double leg) 
  • Hamstring stretches, inc prone knee hangs 
  • Calf raises (bilateral) 
  • Hip Abduction/Extension, +/- theraband 
  • Gait re-education, progress to FWB

Patient should then be seen at 2 weeks for removal of clips

Weeks 2-6: 


  • Wean off crutches if not done so already
  • Eliminate any remaining swelling
  • Maintain full hyperextension
  • Gradual increase of knee flexion to full
  • Restore proprioception/ neuromuscular control, without torsional forces
  • Gradual return to normal ADLs
  • Return to driving when safe
  • Short haul flights only if essential


  • Remove clips
  • Advice on scar massage
  • Continue to strengthen quads- Wall squats, step ups/ step downs
  • Progress shoulder bridges onto gym ball/ single leg
  • Progress calf raises to single leg
  • Address any trunk / pelvic muscle imbalance
  • Proprioceptive re-ed: rope walking, heel/toe walking
  • Static bike

At week 6 there should be a follow up ACL clinic appointment with X-ray on arrival

Weeks 6-12:


  • Swimming, but no breaststroke until 3 months 
  • Free cycling 
  • Full squat 
  • Unrestricted walking 
  • Progress single leg strength 
  • Progress proprioception wobble board, trampette, reaching out of base of support 
  • Jogging on trampette with no pain/swelling 
  • Hopping without pain or swelling 
  • Maintain flexibility

NOTE: Exercise will progress during this stage, but the graft is at its greatest risk of failure during this stage as it is going through the process of revascularisation and ligamentisation.


  • Single leg squats
  • Lunges
  • Single leg sit to stand 
  • Wii fit
  • Skipping Jogging on trampette 
  • Plyometrics- Progress from double leg to single leg 
  • Can begin free cycling 
  • Can return to golf 10-12 weeks 
  • Open chain tibial rotation exercises 
  • Able to fly long and short haul if necessary

Week 12- ACL clinic appointment and can return to physically active 

Weeks 12-16:


  • Enhance lower limb confidence and function 
  • Increase functional activities and endurance/general fitness 
  • Maintain motivation 
  • Able to hop and jump with good control and no exacerbation of symptoms 
  • Able to walk 15 mins everyday pain free with no swelling immediately after and the next morning 
  • Start running and gentle sport specific training


  • Progress plyometric work 
  • Quick feet 
  • Pivoting exercises/ figure of 8 
  • Gentle sport specific exercises

4-6 Months:


  • Increase speed of balance reactions and improve coordination 
  • Advice about returning to chosen sport and exercises to continue with
  • Prepare physical and psychological ability to complete return to sporting activity 
  • Progress sport specific exercises and drills


  • Shuttle runs 
  • Cariocas 
  • Changes of direction at speed 
  • Work on slopes (inclined bench- up, down, sideways, gradually increase speed and angle) 
  • Work to fatigue point 
  • Increase sport specific training gradually. Non competitive

6 Months- Return to sport


  • Return to training for chosen sport and may have started to integrate into competitive game


  • Advise 3 months training prior to full competition to retrieve skill levels and regain confidence 
  • Emphasise importance of warm up and cool down

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