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 0–30°
4. Therapeutic Exercises
   • Quadriceps strengthening / straight-leg raise with brace in full extension until quad strength prevents extension lag
   • Patellar mobilization
   • 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 30°
3. Range of Motion – Maintain full knee extension; work on progressive knee flexion (goal: 0–60° by week 6)
4. Therapeutic Exercises
   • Continue with Phase I exercises

Phase III (Weeks 6-8)

1. Weightbearing: Full weightbearing
2. Hinged Knee Brace: Open between 0 and 60°
3. Range of Motion – PROM / AAROM / AROM – progress to full ROM
4. Therapeutic Exercises
   • Continue with quadriceps strengthening
   • 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 Exercises
   • Half squats / step downs
   • Proprioception activities
   • Closed-chain strengthening
   • Start stationary bike

Phase V (Months 3-9)

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