30 SECONDS OF THERAPY: Anterior Cruciate Ligament (ACL) Reconstruction

May 7

5 min read

START

Prioritizing early restoration of full extension and quadriceps activation.
1. Failure to achieve early extension is a common source of long-term dysfunction. Passive knee extension techniques (e.g., prone hangs, heel props) combined with quad sets—focus on 45°–90° of knee flexion to minimize overloading graft.
2. Electrical stimulation (ACL Rehab Protocol)
Integrating neuromuscular control and feed-forward training.
1. Closed-chain movements,
2. balance training,
3. Perturbation exercises
Following validated protocols grounded in clinical guidelines.
1. Follow surgeon rehab protocol if available, or use this one if not.
  1. (ACL Rehab Protocol)

STOP

Allowing substitution patterns to persist.
1. Poor Load Acceptance: Demonstrates limited time on injured limb and excessive speed of progression with the uninjured limb.
  1. Excessive knee flexion in stance
  2. Flat foot contact
Progressing patients based on time alone.
1. Chronological markers are insufficient. Instead we have functional and measurable outcomes.
  1. Decisions Criteria
    1. Progress A
    2. Progress B
    3. Progress C (ACL Exercises PDF)
Using the same protocol for all graft types.
1. Different grafts have different implications for early rehab. Rehab must match the surgical construct to avoid stressing the donor site or newly placed graft.
  1. Hamstring Allow Graft
  2. Bone Patellar Tendon Bond Protocol
  3. Auto Graft Cadavor (ACL Exercises PDF)

WHY

Why is early knee extension critical post-ACL reconstruction?
1. Achieving full extension early minimizes the risk of arthrofibrosis, facilitates normal gait, and improves quadriceps activation. Delayed extension can cause persistent stiffness, patellofemoral pain, and long-term functional limitations.
Why is return-to-sport testing not sufficient alone?
1. Although RTS tests provide benchmarks, multiple studies have shown no consistent link between test completion and reinjury prevention. Symmetry in quadriceps strength and movement quality is more predictive of safe return. Combining objective testing with delayed timelines improves long-term outcomes.

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