ACL Reconstruction with BPTB Autograft
Physical Therapy Protocol
ACL Reconstruction with Bone-Patellar Tendon-Bone (BPTB) Autograft
General Guidelines
- Brace Settings: Immobilizer until straight leg raise (SLR) without sag.
- Weight-Bearing: 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).