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ACL Reconstruction BTB Auto Allograft

This document outlines a rehabilitation protocol following a Galland/Kirby ACL reconstruction using a bone-tendon-bone autograft or allograft. The protocol is divided into phases from post-op days 1-14, weeks 2-4, weeks 4-6, weeks 6-9, weeks 9-12, months 3-4, months 4-6 with specific exercises and goals for range of motion, strength and function outlined for each phase. The overall goal is to safely regain full strength and function and return to all activities including contact sports by 6 months post-op.

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Paul Radulescu - Fizioterapeut
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62 views5 pages

ACL Reconstruction BTB Auto Allograft

This document outlines a rehabilitation protocol following a Galland/Kirby ACL reconstruction using a bone-tendon-bone autograft or allograft. The protocol is divided into phases from post-op days 1-14, weeks 2-4, weeks 4-6, weeks 6-9, weeks 9-12, months 3-4, months 4-6 with specific exercises and goals for range of motion, strength and function outlined for each phase. The overall goal is to safely regain full strength and function and return to all activities including contact sports by 6 months post-op.

Uploaded by

Paul Radulescu - Fizioterapeut
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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GALLAND/KIRBY ACL RECONSTRUCTION: BONE-TENDON-

BONE AUTO / ALLOGRAFT POST-SURGICAL


REHABILITATION PROTOCOL
POST-OP DAYS 1 – 14
• Dressing:
– POD 1: Debulk dressing, TED Hose in place
– POD 2: Change dressing, keep wound covered, continue TED Hose
– POD 7-10: Sutures out, D/C TED Hose when effusion resolved
• Brace x 4 weeks – Locked in extension for ambulation
– Open to available range when pt has good quad control (no extensor lag)
• Crutches – weight bearing as tolerated (WBAT) in brace (D/C when gait is normal –
generally at 2 weeks)
• Patellar mobilization (teach patient)
• Calf pumping
• AAROM 0-90 degrees (passive extension, active flexion, heel slides)
• Passive extension with heel on bolster or prone hangs
• Electrical stimulation in full extension with quad sets and SLR
• Quad sets, Co-contractions quads / Hamstring
• Straight leg raise (SLR) x 4 on mat (in brace if poor quad control)
• Mini squats – 0-45 degrees in parallel bars
• Weight shifts
• Total Gym (level 3-5) – Mini squats 0-45 degrees
– Passive flexion to 90 degrees max (push up with opposite leg)
• Leg press 0-45 degrees with light resistance (up to ¼ body weight)
• Hamstring curls – Carpet drags or rolling stool (closed chain)
• Double leg heel raises
• Parallel bar ambulation – Forwards / backwards / lateral
• Stationary bike for ROM – Complete cycle as able
• Ice Pack with knee in full extension after exercise

GOALS
• Full passive extension

1
• Flexion to 90 degrees
• Good quad control

Weeks 2 - 4
• Brace x 4 weeks – Open to available range
• Crutches – WBAT, D/C when gait is WNL
• Continue appropriate previous exercises and following ex without brace
• Scar massage when incision healed
• AAROM, AROM through full range as tolerated
• Electrical stimulation – Continue as needed
• SLR x 4 on mat – Add light ankle weights if quad control is maintained
• Wall squats – No knee flexion past 45 degrees
• Total Gym – Progress levels of Mini-squats, 0-45 degrees
• Leg Press 0-45 degrees with resistance no more than ½ body weight
• Hamstring curls on weight machine with light resistance
• Forward, lateral and retro step downs in parallel bars
– No knee flexion past 45 degrees (small step)
• Single leg heel raises
• Proprioceptive training – Single leg standing in parallel bars
– Double leg BAPS for weight shift
• Stationary bike – Progressive resistance and time
• Treadmill – Forwards and backwards walking
• Stretches – Hamstring, Hip Flexors, ITB

GOALS
• ROM 0-110 degrees
• No effusion
• No extensor lag

WEEKS 4 - 6
• D/C Brace
• Continue appropriate previous exercises
• PROM, AAROM, AROM to regain full motion
• Standing SLR x 4 with Theraband bilaterally
• Mini squats, Wall squats 0-60 degrees – Progress to single leg
• Leg press 0-60 degrees with resistance no more than ½ body weight
• Forward, lateral and retro step downs 0-60 degrees (medium step)

2
• Proprioceptive training – Single leg BAPS, ball toss and body blade
• Elliptical trainer
• Pool therapy – Walking / running (no kicking)

GOALS
• Full ROM
• Normal gait

WEEKS 6 - 9
• Continue appropriate previous exercises
• Wall squats 0-90 degrees
• Leg press 0-90 degrees with resistance as tolerated
• Hamstring curls with resistance as tolerated
• Forward, lateral and retro step downs 0-90 degrees (large step)
• Hip weight machine x 4 bilaterally
• Proprioceptive training – Grid exercises
• Stationary bike – 15-20 minutes at a time, at least 70 rpm
• Treadmill – Walking progression program

GOAL
• Walk 2 miles at 15 min/mile pace

WEEKS 9 - 12
• Continue appropriate previous exercises with progressive resistance
• Fitter
• Slide board
• Functional activities – Figure 8s, gentle loops, large zigzags
• Stairmaster – Small steps
• Pool therapy – No swimming laps
• Quad stretches

GOAL
• Walk 3 miles at 15 min/mile pace

MONTHS 3 - 4
• Isokinetic testing at 180 and 300 degrees/sec – Must have 80%
• of opposite leg to clear for straight line running
• Continue appropriate previous exercises
• Knee extension weight machine
3
• Short arc quads
• Agility drills / Plyometrics
• Treadmill – Running progression program if cleared
• Pool therapy – Swimming laps

GOAL
• Run 2 miles at easy pace

MONTHS 4 - 6
• Repeat Isokinetic testing as needed
• Continue appropriate previous exercises
• Sit-up progression
• Running progression to track
• Transition to home / gym program

GOAL
• Return to all activities

*NO CONTACT SPORTS UNTIL 6 MONTHS POST-OP*

DEVELOPED BY: ADAPTED FROM:


Mark Galland, MD Physical Therapy Section
Kenneth Kirby, PT, DPT William Beaumont Army Medical Center

4
KNEE POST-OP PHASE I
Perform exercises below frequently: 30 reps, 3 – 5x a day

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