ACL and MCL Repair

Physical Therapy Protocol

Phase I – Protection Phase (Weeks 0–2)

Goals:

• Protect surgical repair of ACL and MCL.
• Minimize swelling and pain.
• Prevent stiffness and quadriceps atrophy.
• Initiate controlled motion.

Precautions / Restrictions:

• Weight Bearing: Non-weight bearing (NWB) with crutches at all times.
• Brace: Locked in full extension (0°) at all times, including during sleep.
• Range of Motion: Passive only, 0–90°; no active knee flexion.
• Avoid varus and valgus stress to the knee.

Therapeutic Exercises:

• Ankle pumps.
• Quadriceps sets.
• Hamstring sets.
• Straight leg raises (in brace).
• Heel slides to 90° (passive only).
• Patellar mobilizations.

Modalities:

• Ice and compression.
• E-stim for quadriceps activation.

Phase II – Early Motion Phase (Weeks 2–6)

Goals:

• Increase passive ROM to full.
• Initiate neuromuscular control.
• Maintain protection of ACL and MCL healing structures.

Precautions / Restrictions:

• Weight Bearing: Continue non-weight bearing (NWB) with crutches.
• Brace: Locked in extension when ambulating.
• Avoid open-chain knee extension.
• Avoid resisted hamstring work.

Therapeutic Exercises:

• Progress passive ROM: heel slides and wall slides.
• Continue quad and hamstring isometrics.
• Begin terminal knee extension.
• Core and hip strengthening without abduction/adduction.
• Balance board or proprioceptive drills (non-weight bearing position only).

Modalities:

• Continue cryotherapy, compression, and e-stim as needed.

Phase III – Controlled Motion Phase (Weeks 6–12)

Goals:

• Achieve full ROM.
• Normalize gait pattern.
• Improve strength and neuromuscular control.

Precautions / Restrictions:

• Weight Bearing: Initiate weight bearing at Week 6 and progress as tolerated.
• Brace: May be unlocked starting Week 6; range of motion should follow patient’s achieved ROM in therapy.
• Avoid high-impact activities.
• Continue to avoid open-chain terminal knee extension against resistance.

Therapeutic Exercises:

• Stationary bike (with appropriate seat height).
• Step-ups and mini-squats in closed-chain range.
• Gait training with progressive WB.
• Proprioceptive and balance drills (e.g., weight shifts, balance board).
• Initiate resistance training for core, hips, and lower extremity as tolerated.

Phase IV – Advanced Strengthening (Weeks 12–20)

Goals:

• Enhance muscular strength and endurance.
• Improve single-leg control and coordination.
• Prepare for return to higher-level function.

Precautions / Restrictions:

• Weight Bearing: Full weight bearing without assistive device if gait is normalized.
• Avoid high-impact activities until cleared.

Therapeutic Exercises:

• Resistance training for quads, hamstrings, and hips.
• Lateral movements, lunges, and agility drills.
• Plyometric drills (box jumps, jump lunges) as tolerated.
• Progress single-leg balance and strength.

Phase V – Return to Sport Phase (Weeks 20+)

Goals:

• Return to full, unrestricted athletic activity.
• Safely transition to sport-specific movements.

Precautions / Restrictions:

• Weight Bearing: Full weight bearing.
• Must pass strength and functional milestones before return to high-impact sports.

Criteria to Return:

• Full, pain-free ROM.
• Strength ≥90% of contralateral leg.
• No instability during dynamic movement.
• Clearance from physician and physical therapist.

Therapeutic Activities:

• Running progression.
• Agility ladders, cutting, and directional change drills.
• Sport-specific training and reactive control exercises.