ACL Rehabilitation : 2 – 4 Weeks After Surgery

ACL (Anterior Cruciate Ligament of the Knee) 

Reconstruction Surgery Rehabilitation Program

2-4 weeks after surgery

The following program should be done under the guidance of a physical therapist.  
Sets and repetitions: 3 x 10 means 3 sets of 10 repetitions.  
2 – 4 weeks after surgery: 

Goals:  

  1. full knee straightening and almost full knee bending motion 
  2. able to contract muscle on top of thigh 
  3. very little pain and decreased swelling
  4. walking normally without crutches or brace
  5. elastic stocking: can discontinue unless there is excessive swelling 
Exercises:
 
  • “Quad sets” – Tighten muscles on top of thigh 5 sec hold 3 x 10.  Do not press the heel down – try to take the pressure off the heel.
    Quad Set #2
  • Straight leg raise: Do this with the brace on until you are able to do a straight leg raise with the knee absolutely straight.  Position: sitting with leg out straight. Tighten the muscles on top of the thigh, lift the leg up towards the ceiling about 12 inches, hold for 5 seconds, then bring leg back down.  Relax all the way, then repeat.  Do 3 x 15 2x/day.
       Straight Leg Raise #2

  • Wall slides to bend the knee: Do for 5 min 2-3x/day.  It is OK to have moderate pain in the knee with bending, but you should not have a large amount of pain.  Lie on your back with feet on wall and knees bent.  Your buttocks should be about 1-2 feet away from wall.  Slide foot down the wall to bend the knee as far as possible.  Hold 10-15 seconds, then slide the foot up the wall using the other leg to push it up.  This is important: don’t straighten out the knee with your own muscle power.  Straighten the knee just enough to relieve the feelings of discomfort.  Then bend it again.
    Wall slides 1 Wall slides 2
  • Stationary bike with moderate resistance.  Begin with 10 minutes, progressing to 15- 20 minutes.  If the bike has an RPM read out, keep it greater than 60 RPM.  Make sure you are not favoring the injured knee. The seat should be high enough so that when the pedal is close to the ground, the knee has just a little bend in it.
  • Hip exercises: on machine or with elastic band.  Do 2-3 sets of 10, 2x/day, standing on the leg that did not have surgery and using the leg that had the surgery.
     Hip Abduction tband 1  Hip Abduction tband 2
     Hip adduction t-band 1 Hip adduction t-band 2
     Hip flexion t-band 1  Hip flexion t-band 2
     Hip extension t-band 1  Hip extension t-band 2

  • Light leg press:  Make sure this is done with the surgical leg all by itself, otherwise one tends to favor the knee.  If you want to do 3 x 15 with the non-surgical leg or both legs together, that is optional. The knee should move from a position of all the way straight (0 degrees and not hyperextended) to a right angle bend in knee (90 degrees).  Do 3 x 15.
     Leg Press #1 Leg Press #2
  • Mini squats:  Stand, tighten the buttocks and squat down about 3-6 inches.  Keep the knees over the toes and not to the inside or in front of the toes.  Keep weight on both legs equally.  Start with 1 x 10.  Discontinue this exercise if it causes pain under the kneecap
  • Heel raises: Do on the leg press machine: Start with 2 x 10 and work up to 3 x 10 with surgical leg.   
    U heel raises on machine #1  U heel raises on machine #2

  • Hamstring curls: Stand with cuff weight on the ankle and flex the knee.  Do this only if there is no pain in the back of the thigh; if a hamstring graft was done, this may not be pain free until you are 6 weeks after surgery.  3 x 10
    alt alt
  • Walk normally: Let the knee bend as the leg moves through the air.  Contact the ground with the heel as you tighten the muscles on the front of the thigh.    
  • Balance: Begin to practice balance on the leg that had surgery: stand with hands on hips and eyes open, progress to eyes closed.  Goal: 30 sec
    Single Leg Balance #1  Single Leg Balance #2

If it is OK with your physical therapist, at week 3 after surgery, can begin:

  • Sideways step-ups: Begin on a small step about 4 inches high.  Keep the hips level.  Make sure the knee stays over the toes and does not go in a ‘knock knee’ position.  There should not be any pain with this  Start with 1 set of 10
    Lateral Step Up #1  Lateral Step Up #2

  • Front step-ups:  Begin on a small step about 4 inches high.  Keep the hips level.  Make sure the knee stays over the toes and does not go in a ‘knock knee’ position.  There should not be any pain with this  Start with 1 set of 10 
    alt alt

  • Stairstepper machine or elliptical:  
    Eliptical