Combined Anterior Cruciate Ligament (ACL) and Medial Collateral Ligament (MCL) Reconstruction

Phase I (Weeks 0-4)

1. Weightbearing:  Touch-down weightbearing
2. Hinged Knee Brace:  Locked in full extension for ambulation and sleeping
3. Range of Motion – PROM 0-30⁰
4. Therapeutic ExercisesQuadriceps Strengthening/ Straight-Leg Raise with brace in full extension until quad strength prevents extension lagPatellar mobilizationNon-weightbearing stretch of the Gastroc/Soleus 
5. Quadriceps Strengthening/ Straight-Leg Raise with brace in full extension until quad strength prevents extension lag
6. Patellar mobilization
7. Non-weightbearing stretch of the Gastroc/Soleus 

Phase II (Weeks 4-6)

1. Weightbearing:  Advance to WBAT using crutches for balance
2. Hinged Knee Brace:  Open between 0 and 30⁰
3. Range of Motion – Maintain full knee extension– work on progressive knee flexion (Goal: 0-60⁰ by week 6)
4. Therapeutic ExercisesContinue with phase I exercises
5. Continue with phase I exercises

 Phase III (Weeks 6-8)

1. Weightbearing:  Full weightbearing
2. Hinged Knee Brace:  Open between 0 and 60⁰
3. Range of Motion – PROM/AAROM/AROM – Progress to full ROM
4. Therapeutic ExercisesContinue with quadriceps strengtheningStart open chain calf strengthening with theraband
5. Continue with quadriceps strengthening
6. Start open chain calf strengthening with theraband

Phase IV (Weeks 8-12)

1. Weightbearing:  Full weightbearing
2. Hinged Knee Brace:  Unlocked
3. Range of Motion – Full ROM
4. Therapeutic ExercisesHalf squats/Step downsProprioception activitiesClosed chain strengtheningStart stationary bike
5. Half squats/Step downs
6. Proprioception activities
7. Closed chain strengthening
8. Start stationary bike

 Phase V (Months 3-9)

1. Advance closed chain strengthening and proprioception activities
2. Start elliptical/jogging at 6 months
3. Return to athletic activity as tolerated at 9 months post-op