ACL Reconstruction with BPTB Autograft & Meniscus Repair

Physical Therapy Protocol

Restrictions

Brace:

• Locked in full extension (0°–0°) when upright for 6 weeks.
• May unlock for seated exercises and passive ROM under supervision.
• Discontinue brace at 6 weeks once able to ambulate without a limp.

Range of Motion (ROM):

• Limit PROM to 0–90° for the first 4 weeks.
• Progress ROM gradually as tolerated after week 4.

Weightbearing:

• Non-weight bearing (NWB) for 6 weeks.
• Begin toe-touch weightbearing (TTWB) at 25% body weight at week 6.
• Progress weightbearing by 25% per week to achieve full weightbearing (FWB) by weeks 10–12.

Phase I – Protection & Early Mobility (Weeks 0–6)

Goals:

• Protect the surgical repair.
• Minimize pain and inflammation.
• Prevent quadriceps inhibition and maintain patellar mobility.

Precautions:

• Maintain brace locked in extension except during therapy.
• Avoid active knee extension 0–30°.
• No weightbearing.

Therapeutic Exercises:

• Quad sets, ankle pumps, and hamstring sets (3–5 times/day).
• Patellar mobilizations (supervised).
• PROM within 0–90°.
• Gentle hamstring and calf stretching.

Phase II – Gradual Loading & ROM Progression (Weeks 6–12)

Goals:

• Achieve full passive ROM by week 12.
• Begin gradual weightbearing progression.
• Improve quadriceps activation and neuromuscular control.

Precautions:

• Avoid resisted open chain knee extension 0–30°.
• Continue use of crutches as needed until FWB achieved.

Therapeutic Exercises:

• Progress to closed chain exercises (mini-squats, double leg bridges).
• Balance training on stable surfaces.
• Stationary cycling and aquatic walking.

Phase III – Strengthening & Functional Training (Weeks 12–20)

Goals:

• Restore strength and endurance.
• Normalize gait and functional movements.

Therapeutic Exercises:

• Advance proprioception (single-leg balance drills).
• Progress resistance in closed chain exercises.
• Initiate elliptical and treadmill walking.

Phase IV – Return to Activity (Weeks 20–24)

Goals:

• Prepare for higher-level activities.
• Achieve symmetrical strength and functional stability.

Therapeutic Exercises:

• Begin light jogging progression (if strength >80% of contralateral limb).
• Introduce agility drills (straight plane before multi-directional).

Phase V – Advanced Training & Return to Sport (Weeks 24 and beyond)

Goals:

• Safely return to sport-specific training.
• Pass functional testing before clearance.

Therapeutic Exercises:

• Plyometric and agility training.
• Gradual introduction of cutting and pivoting movements.