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 exercises, proprioception activities.- Begin use of the Stairmaster/Elliptical.- Can 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.