knee- acl- acl semitendinosus reconstruction
This document outlines a comprehensive, phase‑based postoperative rehabilitation program for patients who have undergone anterior cruciate ligament (ACL) reconstruction using a semitendinosus autograft. It is organized into five sequential phases: (I) Immediate Post‑operative (POD 1‑7), (II) Maximum Protection (Weeks 2‑8), (III) Moderate Protection (Weeks 10‑16), (IV) Light Activity (Months 4‑5), and (V) Return‑to‑Activity (Months 6‑7). For each phase the protocol specifies clinical goals, brace and weight‑bearing directives, range‑of‑motion (ROM) targets, detailed exercise prescriptions (including closed‑chain, open‑chain, proprioceptive, plyometric and sport‑specific drills), adjunctive modalities (continuous passive motion, cryotherapy, neuromuscular electrical stimulation, patellar mobilization, pool work), and objective testing criteria (KT‑2000 arthrometer values, isokinetic torque percentages, ROM percentages, strength symmetry). Progression between phases is contingent on meeting explicit criteria such as achieving ≥70 % quadriceps strength, ROM ≥ 125°, minimal effusion, and specific KT‑2000 displacement thresholds. The protocol emphasizes early quadriceps activation, gradual re‑introduction of hamstring work, protection of the graft and patellofemoral joint, and a structured return to sport after 6‑7 months, with continued strengthening for up to one year.
Topics
Immediate Post‑operative Phase (POD 1‑7): Foundations of Protection and Activation
Defines early goals (graft protection, swelling control, extension restoration), brace locked at 0°, partial weight‑bearing with crutches, ROM limits (0‑90°), initial exercises (ankle pumps, quad sets, straight‑leg raises), and modalities (CPM, ice, quad NMES).
Maximum Protection Phase (Weeks 2‑8): Structured Progression and Early Strengthening
Divides weeks 2, 4, 6, 8 with specific brace use, self‑ROM frequency, expanded exercise set (multi‑angle isometrics, leg presses, mini‑squats, lateral lunges, PRE program), introduction of light hamstring curls at week 6, and regular KT‑2000 testing to monitor graft laxity.