Massachusetts General Brigham Sports Medicine
Rehabilitation Protocol for Anterior Cruciate Ligament (ACL)
Reconstruction
This protocol is intended to guide clinicians through the post-operative course for ACL Reconstruction. This protocol is
time based (dependent on tissue healing) as well as criterion based. Specific intervention should be based on the needs
of the individual and should consider exam findings and clinical decision making. The timeframes for expected outcomes
contained within this guideline may vary based on surgeon’s preference, additional procedures performed, and/or
complications. If a clinician requires assistance in the progression of a post-operative patient, they should consult with
the referring surgeon.
The interventions included within this protocol are not intended to be an inclusive list of exercises. Therapeutic
interventions should be included and modified based on the progress of the patient and under the discretion of the
clinician.
Considerations for allograft and hamstring autograft
Early weight bearing and early rehabilitation intervention vary for allograft and hamstring autograft. Please reference
specific instructions below. Expectations are the early return to sport phase will be delayed.
Considerations with concomitant injuries
Be sure to follow the more conservative protocol with regards to range of motion, weight bearing, and rehab
progression when there are concomitant injuries (i.e. meniscus repair).
Post-operative considerations
If you develop a fever, intense calf pain, excessive drainage from the incision, uncontrolled pain or any other symptoms
you have concerns about you should call your doctor.
PHASE I: IMMEDIATE POST-OP (0-2 WEEKS AFTER SURGERY)
• Protect graft
• Reduce swelling, minimize pain
• Restore patellar mobility
• Restore full extension, gradually improve flexion
• Minimize arthrogenic muscle inhibition, re-establish quad control, regain full active extension
• Patient education
o Keep your knee straight and elevated when sitting or laying down. Do not rest with a
towel placed under the knee
o Do not actively kick your knee out straight; support your surgical side when performing
transfers (i.e. sitting to laying down)
o Do not pivot on your surgical side
Walking
• Initially brace locked, crutches (per MD recommendation)
• May start walking without crutches as long as there is no increased pain, effusion, and proper
gait
o Allograft and hamstring autograft continue partial weight bearing with crutches for 6
weeks unless otherwise instructed by MD
• May unlock brace once able to perform straight leg raise without lag
• May discontinue use of brace after 6 wks per MD and once adequate quad control is achieved
• When climbing stairs, lead with the non-surgical side when going up the stairs, and lead with
the crutches and surgical side when going down the stairs