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Table of Contents

Overview
Introduction
Anatomy & Physiology
Mechanism of Injury
Patient Presents
Past Medical History
Physical Exam
Patient Management
• PT Pre-op Rehab
• Surgical Procedure
• PT Post-op Rehab
Typical Protocol
• Maximum Protection
• Moderate Protection
• Minimum Protection
Discharge Summary
Patient Outcome
References

Authors:

Larry J. Petterborg, PhD,

Jennifer Beasley, MS, PT

Alison Gooch, MS, PT

School of Physical Therapy, Texas Woman's University, Dallas TX
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Anterior Cruciate Ligament

Typical Protocol


Maximum protection phase (day 1 to week 4)*
Goal Intervention Intervention
Control pain and swelling Protective bracing, Rest, Ice, Compression, Elevation (PRICE), electrical stimulation (E-stim)
Prevent atrophy of LE musculature Muscle setting, Four-way straight leg raise (SLR), multiple angle isometrics, E-stim/biofeedback, weight bearing activities
Knee AROM at least 0 - 90° and prevention of contractures P/AAROM from 0 - 90°, gravity-assisted wall slides and knee extension, patellar mobilizations, Continuous Passive Motion (CPM) if prescribed
Restore knee strength, as well as surrounding musculature Heel slides, bilateral short arc quad (SAQ) in weight bearing, AROM of knees, stool scoots, stationary cycling and aquatic PT
Independent ambulation with assistive device Gait training education and management of assistive device

* Kisner & Colby 2002


What knee positions should be avoided during maximal protection phase?

Are there any clinically significant differences between the accelerated and non-accelerated ACL rehabilitation programs?


Progress Note 1/13/1997

Right knee AROM 0 to 110°. Right knee PROM 0 to 121°. Strength not tested. Minimal swelling. Full weight bearing on right without crutches, although gait is slightly antalgic. Physician noted excellent stability.

Progress Note 1/28/1997

Right knee AROM 0 to 123°. Strength testing per Cybex isometric evaluation revealed 28, 13, and 26% deficits at 90°, 60°, and 30° of knee flexion respectively. Patient progressed to second stage of ACL rehabilitation protocol.

New short term goal:

Patient will decrease deficits by 10% at all three angles.

Previous: PT Post-op Rehab
Next: Moderate Protection

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Last Update: June 17 2008