1 16

IMMEDIATELY AFTER YOUR SURGERY:

1. You may be fitted with a Bledsoe knee brace in Physical Therapy.
2. Depending on your surgeon, you will be fitted with and instructed in
the use of crutches. You are allowed to put as much weight as you
can tolerate on your leg (unless your doctor tells you differently).
3. You will begin a program of therapeutic exercises with the help of a
physical therapist.
PATIENT GOALS:
1. Range of motion recovery.
A. 10-14 days: 0-90 degrees of knee flexion (able to sit in a chair
with your ankle straight below your knee).
B. 4 weeks: 0-125 degrees of flexion (almost full).
C. 6 months: full range of motion (0-130 degrees).
2. Decrease swelling.
3. Strengthening: Affected leg strength about the same as your other
leg, or legs are similar in size around the thighs (8-12 months).
OVERVIEW OF WHAT IS EXPECTED FOLLOWING SURGERY:
1. Plan to be off work for two weeks, then back at light duty or regular
duty depending on job. If your job requires moderate labor, expect to
return to full duty in three months. If your job requires heavy duty,
expect to return to full duty in 6-9 months.
2. Use ice or cold cuff to help control swelling (use ice after exercises,
as this helps control pain, increase circulation and decrease
swelling).
3. Use crutches as needed to walk safely (depending on your surgeon
and surgery, use of crutches may range from 1-4 weeks).
Alaska Native Medical Center
ACL Protocol
NOTES:
15 2
4. Do your DAILY HOME EXERCISES that you have learned in Physical
Therapy multiple times every day.
5. DO NOT JUMP, RUN, CARRY HEAVY WEIGHTS, OR USE LEG
EXTENSION MACHINES FOR 6-9 MONTHS. DO NOT FULLY SQUAT
OR KNEEL ON AFFECTED KNEE FOR SIX MONTHS.
6. If you were given a brace, wear it when out of bed for 6 weeks
when walking; you may take the brace off while sleeping or resting
at home.
7. Show up to your follow-up appointments with your doctor/physical
therapist.
8. Your graft goes through some changes in strength while healing.
Use this guide to be extra careful during the first three months.
STRENGTH OF YOUR ACL GRAFT
Weakest 4-10 weeks.
3 months = 30 percent strength
6 months = 65 percent strength
9 months = 95 percent strength
12-16 months = 100 percent strength
If you have any questions or concerns regarding your rehabilitation,
call the ANMC Physical Therapy Department at 907-729-1249.
RELATIVE STRESS ON THE KNEE
CAUSED BY DIFFERENT ACTIVITIES
EXTREME
Football
Basketball
Lacrosse
Soccer
Volleyball
Baseball/Softball
Skateboarding
Downhill Skiing
Rowing
Running
Racquetball
Tennis
Berry-Picking
Jazz Dance/Modern Dance/Ballet
Regular Aerobics
Yoga/Low-Impact Aerobics
Weight Lifting (extension against resistance)
Backpacking/Hunting
Stair-Stepper/Stair Master
Ping-Pong
Golf
Flying (with foot pedals)
Roller Blading/Roller Skating on flat terrain
Ice Skating (if you know how)
Cross Country Skiing on flat terrain
Straight leg raises with weights
Walking short distances
Bicycling
Kayaking
Straight leg raises
Sleeping
MILD
3 14
EXERCISES
STRENGTHENING YOUR KNEE FOLLOWING REPAIR TO YOUR ACL
The function of the anterior cruciate ligament (ACL) is to prevent your tibia
(shin bone) from moving too far forward on your femur (thigh bone). To
compensate for an abnormal ACL you must have strong hamstrings (mus-
cles on the back of your thigh) that bend the knee. It is crucial to strength-
en these muscles to prevent re-injury.
Perform these exercises on your _____ Right leg _____ Left leg.
These exercises are to be completed in 3 sets of 10 repetitions 5 times
per day.
HEEL SLIDES: Active
movement while lying on
your back, alternately
bend and straighten
knee. Use the opposite
leg to help as needed.
1
2
HAMSTRING CURLS:
While standing, grasp a
table or chair back for
balance so your back is
straight. Bend the injured
knee up to 90 degrees
then let your foot back
down to the floor.
EXERCISE GUIDELINES
NO EXTENSION AGAINST RESISTANCE.
YES NO STRAIGHT LEG RAISES ISOMETRIC MUSCLE STRENGTHENING
YES NO SWIMMING 10 DAYS AFTER SURGERY IF PORTALS ARE HEALED
(STRAIGHT-LEG KICKING, NO FROG-LEG KICKING)
YES NO BICYCLING ON LEVEL GROUND (OR ON EXERCISE BIKE)
YES NO WALKING SHORT DISTANCES (AS SOON AS COMFORTABLE WITHOUT
LIMPING)
UNTIL DOCTORS RELEASE, DO NOT ATTEMPT THE FOLLOWING ACTIVITIES
YES NO NORDIC TRAC OR CROSS COUNTRY SKIING
YES NO ICE SKATING
YES NO DRIVING OR FLYING (WITH FOOT PEDALS)
YES NO PING-PONG
YES NO WEIGHTLIFTING (UPPER AND/OR LOWER BODY)
YES NO YOGA
YES NO LOW IMPACT AEROBICS
YES NO REGULAR AEROBIC
YES NO DANCING
YES NO ROLLER SKATING OR ROLLER BLADING
YES NO SKATE SKIING
YES NO BACKPACKING/HUNTING
YES NO BERRY PICKING
YES NO RUNNING
YES NO TENNIS
YES NO RACQUETBALL OR SQUASH OR HANDBALL
YES NO DOWNHILL SKIING
YES NO BASEBALL OR SOFTBALL
YES NO VOLLEYBALL
YES NO SOCCER
YES NO LACROSSE
YES NO BASKETBALL
YES NO FOOTBALL OR RUGBY
YES NO GOLF
YES NO STAIR-STEPPER
YES NO JUDO OR KARATE
YES NO BOWLING
YES NO 4-WHEELING
YES NO SNOW HUNTING
YES NO CLIFF CLIMBING
Note: These exercises are to be tried with caution and reasonable length of duration. Discontinue if
there is a noticeable increase in knee pain within 24 hours of any specific activity or exercise. For
episodes of increasing swelling in the weeks and months that follow surgery, reapply cryocuff, ele-
vate, rest and return to straight leg raising exercises. Long distance walking or pacing is a neutral
exercise and does not necessarily strengthen the quadriceps muscles.
13 4
HIP ABDUCTION: While
lying on your uninjured
side with your legs
straight, raise your top leg
straight up then let it
down. Be sure you are
not letting your hips fall
forward or backward. You
may bend your uninjured
knee for balance.
3
HIP ADDUCTION: While
lying on your injured
side with your bottom leg
straight and your top leg
bent, raise your bottom
leg then let it down.
4
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WEEKS MONTHS
WHAT TO EXPECT AFTER
SURGERY AND ONCE YOU
RETURN HOME
Range of Motion
Leg fully straight (prone knee stretch) refer to exercises #9 and 10
Knee bent to 90 degrees or more refer to exercises #1 and 8
Knee bent to 125 degrees or more refer to exercises #1 and 8
Knee bend same as good leg (135-140 degrees)
Stationary bike refer to exercise #15
Stairmaster level 1
Strengthening
Straight leg raise (4 directions) refer to exercises #3,4,5 and 6
Hamstring curls (standing knee bends) refer to exercise #12
Quarter wall squat/single-leg step-up refer to exercises #11 and 14
One-leg heel raise refer to exercise #12
Stairs (normal up/minimal assistance down)
Quarter wall squat, one leg (20 or more times)
One-third to one-half wall squat refer to exercise #11
Lunge
Stairs (run up/walk down, indoor)
Conditioning
Walk on even surfaces without limp
March/backward walk/sidestep
Bike outdoors (level terrain/no toe clips)
Light jog (half-speed, straight/level surfaces)
Bike outdoors (all terrain/seated)
Jog/run (uneven surfaces/turns)
Bike outdoors (all terrain/unlimited)
Agility/Sports
Wobble board/uneven surface (2 legs/no twist)
Single leg stand (30 seconds)
Wobble board/uneven surface (1 leg/eyes closed)
Skipping (both legs)
Hopping drills (2-leg, increasing height/distance)
Hopping drills (1-leg, increasing height/distance)
Grapevine, cutting, figure-eights, etc.
Swim
Nordic Trac/cross country ski
Golf
Active sports (as released by physician)
5 12
HIP EXTENSION: While
lying on your stomach
with your legs straight,
raise your injured leg
then let it down.
5
STRAIGHT LEG RAISES:
While sitting up, keep
your injured leg straight,
raise your leg 12 inches,
hold for five seconds,
then slowly lower it.
6
if off pain pills increasing height and/or distance of hops, running up
indoor/dry stairs and walking down.
4 MONTHS Running on uneven surfaces with turns. You can bicycle,
swim, Nordic track, cross-country ski, and/or golf without restrictions.
5 MONTHS Both hamstring and quadriceps can be exercised with-
out restriction.
6-9 MONTHS You may return to sports if the following conditions
are met:
The size of your affected thigh is 85 percent of the size of your
good thigh.
You have no ACL looseness.
No swelling.
Your joint position awareness of your affected knee is almost
equal to your good side.
You have completed a jog/run program.
Your hop distance is 85 percent of the opposite knee.
You have full knee motion.
All the above conditions met OR your surgeon releases you to play
sports.
11 6
PATELLAR MOBILIZATIONS: In a sitting position with the leg straight
and the thigh muscle completely relaxed. Place the thumb and index
finger at the top and bottom of the knee cap and gently move the knee
cap up and down. Place the thumb and index finger on each side of
the knee cap and move the knee cap from right to left and back.
Direction of motion: up-down, in-out;
hold _____ seconds; repeat _____ times.
7
8
WALL SLIDES: Lying on your back with the involved legs foot support-
ed on the wall, allow the foot to slowly slide down the wall, bending the
knee. Use the opposite leg to return the stretched extremity back to its
starting position.
Hold _____ seconds/minutes; repeat _____ times.
What to expect once you return home
Within 2 weeks, you want to be able to relax your repaired leg to com-
pletely straight so that you can walk without a limp. When you lift your
leg, keep your knee straight]po. A fully straight leg within the first 2
weeks is needed to allow a completely normal walking pattern. Only
straight leg raises for movement of affected leg against gravity.
2-6 WEEKS Emphasize increasing knee motion (can use stationary
bike or stairmaster at level 1), weight bearing, and joint awareness
begin balancing on a wobble board or uneven surface with both legs
(no rotation), marching, walking backwards, side to side, single-leg
stands, single-leg step-ups, and quarter squats. Walk only on even sur-
faces for the first 4-6 weeks.
You should be able to do a single leg stand for 30 seconds, walk without
limping on level surfaces, and go up stairs normally, walking down with
minimal assistance. You should be able to bend your knee 125 degrees by 4
weeks.
By 5-8 weeks your knee motion should be 0-125 degrees and you should
be able to do 20 one-leg quarter-squats in order to begin increasing activities.
6-12 WEEKS Begin balancing on a wobble board or uneven surface
on one leg, one-leg balance with eyes closed, one-leg 1/3 to 1/2 squats,
bike outdoors on smooth, level terrain without toe clips or standing up
while pedaling. Swelling, pain, and warmth will gradually decrease as
your motion increases. Expect swelling to be present up to 3 months or
more. Hamstring reconstruction may start hamstring exercises with
weights.
8-12 WEEKS Light jog (1/2 speed) in a straight line on level surface.
May begin lunges, riding bike on all terrain without standing up while
pedaling, skipping with both legs.
12 WEEKS Hopping drills with both legs then progressing to one leg
7 10
PRONE KNEE STRETCH: Lying on your stomach with the knee cap just
off the edge of the bed. Place a weight around the ankle and let the
weight pull your knee into a straighter position. Or push down on the
ankle of your injured leg with the foot of your good leg.
Hold this position _____ seconds/minutes; repeat _____ times.
9
10
OTTOMAN KNEE STRETCH: In a sitting position, place the heel and
ankle of the injured leg on a towel roll or footrest with the knee joint
unsupported. Allow gravity to push the knee straight. Weight may be
added to the leg to increase the stretch. Do not allow the hip to roll
outward.
Hold this position _____ seconds/minutes; repeat _____ times.
STATIONARY BIKE:
Pedal forward or back-
ward. Adjust bike so the
leg is nearly straight
when pedal is at its far-
thest position in the rota-
tion.
Do for _____
minutes per day.
15
16
FORWARD WALK WITH
TUBING: With tubing
around waist, walk for-
ward two or three steps.
Walk back to start.
Repeat _____ times or do
for _____ minutes. Do
_____ sessions per day.
9 8
12
STANDING SINGLE-LEG
HEEL RISE: Balance on
the injured leg then rise
up on ball of foot.
Repeat _____ times per
set. Do _____ sets per ses-
sion. Do _____ sessions
per day.
11
QUARTER SQUAT: With
feet shoulder width apart
and your back against the
wall, slide down the wall
until the knees are bent
at a 30-45 degree angle.
Repeat _____ times or do
for _____ minutes. Do
_____ sessions per day.
THE FOLLOWING EXERCISES CAN BE STARTED
2-4 WEEKS AFTER YOUR SURGERY. THESE EXERCISES
ARE ONLY TO BE DONE IF PAIN-FREE!
14
SINGLE LEG STEP-UP:
With foot of injured leg
on step, step up. Return
to beginning position.
_____-inch step. Repeat
_____ times or do for
_____ minutes. Do _____
sessions per day.
13
QUARTER SQUAT WITH
TUBING: With feet shoul-
der width apart, stand on
tubing and pull to hip
height. Bend knees 30-45
degrees. Return to
straight position.
Repeat _____ times or do
for _____ minutes. Do
_____ sessions per day.