ACL Bone-Patella-Bone Reconstruction

Rehab Protocol

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.