ACL Reconstruction with Bone-Patellar Tendon-Bone (BPTB) Autograft

Physical Therapy Protocol

General Guidelines

• Brace Settings: Immobilizer until straight leg raise (SLR) without sag.
• Weight-Bearing: Weight-bearing as tolerated (WBAT) with crutches until normal gait is restored.
• Range of Motion (ROM) Restrictions: Full passive motion encouraged.

Phase 1: Weeks 0–2 – Maximum Protection

Goals:

• Reduce pain and inflammation.
• Protect the graft.
• Initiate quadriceps activation.

Exercises:

• Wall slides, seated flexion/extension.
• Patella/tendon mobilization.
• Extension mobilization.
• Quad sets, hamstring activation.
• Gentle sit-and-reach for hamstrings.
• Ankle pumps.

Phase 2: Weeks 3–6 – Progressive Range of Motion

Goals:

• Restore functional ROM.
• Improve quadriceps control.

Exercises:

• Toe and heel raises.
• Balance series.
• Bike (Well Leg Only) → Progress to Both Legs (No Resistance).

Phase 3: Weeks 7–12 – Strengthening & Cardiovascular

Goals:

• Improve muscular strength and endurance.
• Normalize gait without assistive devices.

Exercises:

• Bike with resistance, elliptical trainer.
• Aqua jogging (start Week 6), treadmill walking (start Week 12).
• Weight-bearing strengthening: Double knee bends, bridges, lunges.

Phase 4: Weeks 13–20 – Advanced Strength & Agility

Goals:

• Improve balance and proprioception.
• Introduce controlled plyometric exercises.

Exercises:

• Balance squats, single-leg deadlifts, leg press.
• Running progression: Initial single-plane → Multi-directional.

Phase 5: Weeks 20–24+ – Return to Sport

Goals:

• Achieve full return to sport-specific activities.
• Prevent re-injury through neuromuscular training.

Exercises:

• Functional sports test, advanced plyometric drills.
• Sports return: Golf, biking (Week 16), skiing, basketball, tennis (Week 20).