Post- ACL Reconstruction Physiotherapy rehabilitation

Post- ACL Reconstruction Physiotherapy rehabilitation | ACLR

Post- ACL Reconstruction Physiotherapy rehabilitation

Since Post- ACL Reconstruction Physiotherapy rehabilitation is divided into several phases in which the first phase’s goal is to regain normal joint function and it should be focusing on decreasing swelling, reaching full extension, reaching normal Patello-femoral joint motion, selective quadriceps control, and normal walking gait.

If the reconstruction is done with a patella-bone-patella graft hence the external resistance is allowed after 4 weeks. Otherwise, in hamstring graft reconstruction external resistance is only allowed after 12 weeks.

In the first 3 to 4 weeks of Post- ACL Reconstruction it’s safe to train in a range of motion of 0 to 60 degrees of flexion during the squat or leg press.

Importance of ACL

ACL has along with mechanical function there is also neuromuscular function as it has mechanoreceptors, these receptors are responsible for the detection of positional changes in the joint and also facilitate protective reflexes. After an ACL injury, there is no new growth of mechanoreceptors, therefore it is important to start with neuromuscular training, and balance exercises, in an early stage.

Physiotherapy Rehabilitation

The first phase (o-8 weeks) of Post- ACL Reconstruction Physiotherapy rehabilitation started with-

After ACL reconstruction weeks 1-

Cryotherapy, will reduce pain and swelling as well.

TENS also helps in reducing pain.

Isometric exercises.

Patella mobilization.

Ankle pumps.

After ACL reconstruction weeks 2-

Mobility exercises for example heel slides and knee extension with a towel kept under the knee.

Standing with 50-70 percent body weight.

Wall squats with knee flexion up to 60 degrees.

Prone knee extension with ankle lifted on the pillow.

After ACL reconstruction weeks 3 to 4-

Static cycling.

Standing knee extension against the resistive band, or ball behind the knee.

Squatting and leg press up to 60 degrees only.

Gait training with the crutch.

Isometric, concentric & eccentric exercise in the close chain.

After ACL reconstruction after week 4-

Open chain knee extension exercises only after the 4th week, and start with 90 to 45 degrees first and add 10 degrees each week like on the 5th week it will be 90 to 35 degrees. But open-chain exercises like active leg raises and side-line abduction don’t strain the ACL and can be performed from the first week.

Heel raises.

Also, Hip hinges.

Proprioception, balance & coordination training.

Finally, at the end of the first stage of Post- ACL Reconstruction Physiotherapy rehabilitation, the new range of motion should be 120 to 130 degrees of flexion and 0 degrees of extension. And the patient can walk without crutches and the gait should be symmetrical. This stage takes up to 6 to 8 weeks.

The second phase of Post- ACL Reconstruction Physiotherapy rehabilitation includes-

During the 2nd phase, the goals of the Second phase Post- ACL Reconstruction Physiotherapy rehabilitation are that patients can perform sports-specific activities, perform physically demanding work.

You can do open chain knee extension in full ROM from week 12, and also you can apply external resistance.


Iso-kinetic exercises such as forward, backward & lateral dynamic movement programs.

Start jogging in around 10 to 12 weeks, or treadmill training.


Deep squats.

Plyometric training.

Endurance & strength training.

Agility training.

And finally sports specific training and conditioning.

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