Young woman having leg injury. Close up male hands massaging leg of an injured woman at the gym. Sport injury concept.

ACL/MCL Reconstruction/Repair Protocol

Weeks 0 – 4 (Acute)

Range of Motion

  • Weeks 0 -1 
    • Flexion 0 to 30 degrees
  • Weeks 1 – 2
    • Flexion 0 to 60 degrees
  • Weeks 2 – 4
    • Flexion 0 to 90 degrees

Weightbearing

  • Weeks 0 – 2
    • Toe-touch weightbearing
  • 2+ Weeks
    • Weightbearing as tolerated

Brace

  • Weeks 0 – 2
    • Braced locked at 0 degrees until 10 straight leg raises
  • Weeks 2 – 4
    • Brace 0 to 60 degrees
  • 4+ Weeks 
    • Open and discontinue once gait is normal

Weeks 6 – 12 Phase 2 (Strength)

Range of Motion

  • Progress to full flexion

Strengthening

  • Leg press, step ups, step downs, wall sits 
  • Squat progression: bodyweight squats 
  • Advance hip abduction & glut strength 
  • Core exercises 
  • Balance training

Conditioning

  • Stationary bike: interval training
  • 6+ Weeks — Elliptical & rowing machine 
  • Initiate dynamic warm-up

Weeks 12 – 24 Phase 3 (Agility/Plyometrics)

Conditioning

  • Dynamic warm-up & integrate sport specific warm up 
  • Biking, elliptical, jogging, swimming, & rowing 
  • Treadmill walk/jog progressions

Plyometrics

  • Ladder drills, footwork agility drills, cone drills 
  • Double leg plyos 
  • High intensity predictable patterned movements, incoporate sport specific drills

Weeks 24 – 28 (Phase 4)

Strengthening

  • Gym strengthening: squats, deadlifts, olympic lifting 
  • Interval strength circuits 
  • Dynamic eccentric loading: double & single leg 
  • Dynamic core 
  • Isokinetic training protocols

Conditioning

  • Dynamic warm-up 
  • Biking, elliptical, jogging, swimming & rowing 
  • Advance to linear speed drills and sprinting drills

Plyometrics

  • Tuck jumps, squat jumps, bounding, SL hop, SL triple hop, SL cross over hop 
  • Change of direction drills 
  • Non-contact sports specific drills

Weeks 28 – 36 (Return to Play)

Strengthening

  • Gym strengthening: squats, deadlifts, and olympic lifting
  • Interval strength circuits & work/rest timed intervals  
  • Complex movement patterns 
  • Isokinetic protocols: 300°, 180°, and 60°/sec

Conditioning

  • Jogging, biking, swimming, rowing, & interval sprint workouts

Plyometrics

  • Max effort DL and SL jumps 
  • Lateral & rotational agility drills 
  • Return to practice 🡪 return to contact practice 🡪 return to scrimmage 🡪 return to interval play 🡪 return to full play
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