Anterior Cruciate Ligament (ACL) Reconstruction with Bone-Patellar Tendon-Bone Autograft

Phase I (Weeks 0-4)

1. Weightbearing: As tolerated with crutches (may be modified if concomitant meniscal repair, meniscal transplant, or articular cartilage procedure is performed)
2. Hinged Knee Brace
   • Locked in full extension for ambulation and sleeping (Weeks 0–1)
   • Unlocked for ambulation and removed while sleeping (Weeks 1–4)
3. Range of Motion – AAROM → AROM as tolerated
4. Therapeutic Exercises
   • Quad / Hamstring sets
   • Heel slides
   • Non-weightbearing stretch of the Gastroc / Soleus
   • Straight-leg raise with brace in full extension until quad strength prevents extension lag

Phase II (Weeks 4-6)

1. Weightbearing: As tolerated — discontinue crutch use
2. Hinged Knee Brace: Discontinue brace use when patient has achieved full extension with no evidence of extension lag
3. Range of Motion – Maintain full knee extension; work on progressive knee flexion
4. Therapeutic Exercises
   • Closed-chain extension exercises
   • Hamstring curls
   • Toe raises
   • Balance exercises
   • Progress to weightbearing stretch of the Gastroc / Soleus
   • Begin use of the stationary bicycle

Phase III (Weeks 6-16)

1. Weightbearing: Full weightbearing
2. Range of Motion – Full / painless ROM
3. Therapeutic Exercises
   • Advance closed-chain strengthening and proprioception activities
   • Begin use of the Stairmaster / Elliptical
   • Start straight-ahead running at 12 weeks

Phase IV (Months 4-6)

1. Gradual return to athletic activity as tolerated
2. Maintenance program for strength and endurance