Anterior Cruciate Ligament (ACL) Reconstruction with Hamstrings Autograft

Phase I (Weeks 0-6)

1. Sling immobilization for first 6 weeks – out of sling to do home exercise program (pendulums) twice daily
2. Therapeutic Exercise
   • Grip Strengthening
   • Elbow / Wrist / Hand Exercises
   • Teach Home Exercises — Pendulums
3. Heat / Ice before and after PT sessions

Phase II (Weeks 6-12)

1. Discontinue sling
2. Range of Motion – PROM → AAROM → AROM, increase as tolerated
   • Begin Active Internal Rotation and Backward Extension as tolerated
   • Goals: >90° Forward Flexion and 30° External Rotation
3. Therapeutic Exercise
   • Begin light resisted exercises for Forward Flexion, External Rotation and Abduction – isometrics and bands – concentric motions only
   • No Resisted Internal Rotation, Backward Extension or Scapular Retraction
4. Modalities per PT discretion

Phase III (Months 3-12)

1. Range of Motion – Progress to full AROM without discomfort; gentle passive stretching at end range
2. Therapeutic Exercise
   • Begin resisted Internal Rotation and Backward Extension exercises
   • Advance strengthening as tolerated – Rotator Cuff, Deltoid and Scapular Stabilizers
   • Begin eccentric motions, plyometrics and closed-chain exercises
3. Modalities per PT discretion