ACL Bone-Patella-Bone Reconstruction
Rehab Protocol

Keys to a Successful Outcome

Crutches should be used after surgery until the patient feels safe walking without them.
Ice should be used liberally for the first two weeks
The graft construct/knee is weakest and most susceptible to failure about 6 weeks from surgery. After that, it starts to heal in and become stronger.

Phase	Brace	ROM	WB	Exercises
Weeks 0-4	Weeks 0-1: Locked in full ext; Weeks 1-4: unlocked for ambulation, remove for sleeping*	As tolerated	Full in brace	Heel slides, quad/ham sets, patellar mobs, gastroc/soleus stretch; SLR w/ brace in full ext until quad strength prevents ext lag; side-lying hip/core
Weeks 4-12	Discontinue at day 28 if patient has no ext lag	Full	Full	Begin toe raises; progress quad/ham exs; stationary bike; progress hip/core training
Weeks 12-16	None	Full	Full	Advance closed chain strengthening; progress proprioception activities; begin stairmaster/elliptical at 8 wks; forward jogging at 12 wks.
Weeks 16-24	None	Full	Full	Week 16: Begin jumping Week 20: advance to sprinting, C.O.D. drills; initiate plyo program and sport-specific drills**
>6 Months	None	Full and pain-free	Full	Gradual return to sports participation

*Brace may be removed for sleeping after first post-operative visit (day 7-10). Crutches can be used until it is safe to walk without them.