Anterior Cruciate Ligament

Typical Protocol

Moderate Protection Phase (4 weeks to 10 weeks)*

Goal Intervention	Intervention
Full ROM and flexibility	Grade III joint mobilizations, prone knee extension, stretching LE musculature
Increase strength, endurance and control of knee and surrounding musculature	Within protected range: Progressive closed chain exercises, Progressive Resistive Exercises (PRE) using free weights, machines, Theraband
Improve proprioception, balance, and stability	Balance activities on different surfaces, manual perturbations, BAPS board, tilt board
Improve cardiorespiratory fitness	Treadmill walking, stationary cycling, upper body ergometer (UBE)
Independent ambulation with full weight bearing	Progressive gait activities if necessary

* Kisner & Colby 2002

---

What are the criteria for progression into the moderate protection phase?

---

Progress Note 2/6/1997

Right knee AROM 0 to 127°. Strength per Cybex isometric measurements showed a 20 and 26% deficit in quadriceps at 90° and 30° of flexion. No swelling. Patient is full weight bearing with no gait deviations.

Progress Note 2/20/1997

Cybex isokinetic testing revealed deficits in concentric quadriceps contraction of 50, 34, and 45% at 60, 180 and 300° per second, respectively. Deficits of 43, 34, and 30% in hamstrings concentric contraction occurred at 60, 180 and 300° per second, respectively. Patient has met all short term goals.

New short term goal:

Patient will decrease deficits in isokinetic contraction of both quadriceps and hamstrings by at least 15%.

Progress Note 3/6/1997

New short term goals:

1. Patient will decrease deficits by approximately 10% at all angles of quadriceps and hamstrings concentric contraction.
2. Patient will begin lateral movement with functional activities with no pain noted.
3. Patient will decrease deficit for one leg single hop for distance by 10%.

Progress Note 3/20/1997

Patient reports her knee is “feeling better” with normal functional activities and has no increase in symptoms. Physical therapy at this time consists of upright bike and Stairmaster to increase cardiovascular endurance. Patient is on a progressive resistive exercise program including exercises such as leg press, terminal knee extension, hip abduction, bilateral mini squats, hamstring curls, Cybex isokinetic machine. Proprioceptive training on compliant surfaces has been initiated, and functional activities continue to be progressed. Following therapeutic exercises, patient receives functional electrical stimulation and a cold pack. The patient is now released to participate in running program with her basketball team.

---

When can straight-line running be introduced into the rehabilitation program?

---

Progress Note 4/3/1997

Patient reports compliance with HEP. Right knee AROM WNL. Strength continues to improve. One leg single hop test demonstrates 17% deficit on the left. Patient progressed to final stage of ACL Rehabilitation protocol. Short term goals met.

New short term goal:

Patient will decrease deficit for one leg single hop for distance by an additional 5%.