Mehul R Shah, M.D. - Orthopaedic Surgeon - New York Hospital for Joint Diseases - NYU LANGONE MEDICAL CENTER
Mehul R Shah, M.D. - Orthopaedic Surgeon - New York, NY: 212-598-3897, 646-501-7417 - Lake Success, NY: 516-467-8600
Patient Info

ACL Reconstruction Guidelines

Day1 to week 2

  • CPM 2 hours twice per day; increase ROM as tolerated, Discontinue when 0 - 110o achieved
  • Ice as indicated, no more than 15 minutes each hour
  • WBAT with crutches. Discontinue crutches if able to stand on involved leg with brace locked
  • Drop lock knee brace in locked position except when exercising. Remove brace for therapeutic exercises and CPM
  • PROM per patient tolerance; 0 - 110°; stress full extension
  • Supine and prone sustained extension stretching.  Never put anything under the knee
  • Soft tissue mobilization of scar
  • Supine wall slide
  • Seated hamstring (carpet drags) / prone hamstring curls / sports cord knee flexion
  • Stationary bicycle
  • Isometric quadriceps contraction in complete / supported extension.
  • Biofeedback, NMES, etc.; techniques to overcome quad inhibition
  • SLR x 4 directions without extension lag, resistance above the knee. If lag, patient may perform SLRs with brace locked
  • Isometric quadriceps contractions at.0 and 65° with/without electric stimulation
  • Patella mobilizations
  • Modalities to decrease swelling and pain
  • Flexibility exercises: hamstrings, quadriceps, gastrocsoleus, ITB, and hip flexors
  • Airdyne and UBE aerobic program / Upper body and core strengthening program

Week 2 - 3

  • Continue with the above program
  • PWB balance activities
  • Bilateral "mini-squats" (0 - 40°); progress to semi-squats (0-80°)
  • Bilateral Leg Press (0-80°)
  • Bilateral calf raises
  • Unlock brace for sitting (monitor for loss of extension). Continue with locked brace for sleeping
  • Unlock brace for ambulation if SLR without lag

Week 3 - 4

  • Discontinue brace at night if extension is maintained
  • Step-ups
  • Walking on heels
  • FWB balance and proprioception exercises (provided adequate quad control)

Week 4 - 5

  • Discontinue brace for ambulation. Monitor for loss of extension
  • Short arc quads; isolated quad strengthening
  • Wall sits (consider PFP)
  • Unilateral eccentric leg press
  • Stairmaster as tolerated
  • Lateral shuffles
  • Double leg hops
  • Profitter & slide board

Week 6 - 8

  • Full arc quads / Isokinetic program - progress as tolerated (monitor for patellofemoral pain)
  • Single-limb hopping on leg press
  • Eccentric "star" taps
  • Eccentric step downs
  • Aquatic program if applicable
  • Record Isokinetic test, KT-1000, KOS @ 6 weeks
  • Introduce perturbation progression

Week 8-12

  • Single leg hops on ground
  • Unilateral Eccentric Leg Press
  • Progress step height for step ups/down
  • Bosu or stability step-ups
  • Record Isokinetic test, KT-1000, Hip MMT, KOS @ 12 weeks
  • Unilateral "minisquats" (0 - 40°)
  • Advance in perturbation training

Week 12 to 20

  • Roller-blading and ice-skating as tolerated. (Check with physician, may need ACL orthosis)
  • Plyometrics program; box jumps, scissor jumps
  • Jogging straight ahead
  • Jumping rope
  • Lunges sideways / forward

Week 20 - 36

  • Cutting I Agility drills and sports-specific training
  • Reactive jumping
  • Record Isokinetic test., KT-1000, Hip MMT, KOS @ DC

Week 36 - Return to Sport (52 wks for Allograft)

Advance to full sports activities if  <20% strength deficit. Brace if KT-1000 >5mm and <3mm improvement from pre-op, Single-Limb Hop test ≥80% of uninvolved LE.

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Sports Medicine - Mehul R Shah, M.D.
Knee Arthroscopy - Mehul R Shah, M.D.
ACL Reconstruction - Mehul R Shah, M.D.
Shoulder Arthroscopy - Mehul R Shah, M.D.
Ankle Arthroscopy & Reconstruction - Mehul R Shah, M.D.
Platelet Rich Plasma (PRP) Injections - Mehul R Shah, M.D.
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