ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

DROITWICH PROTOCOL

This may be carried out using a graft from the patellar tendon (PTG), quadriceps tendon (above the patella) or gracilis/semitendinosus (hamstrings graft).

Acute Stage (Immediately post-op)

• C.P.M. 0 - 60 degrees
• Full passive extension - 5 minute stretches (x 5 daily)
• Pain relief – Ice, drugs
• Partial weightbearing - use of crutches for comfort
• Isometric quadriceps exercises in full extension
• Muscle pump exercises
• Simple closed kinetic chain exercises (eg: heel raises, mini squats, weight transference)

Seven Days (when swelling has gone down)

N.B. Check that full extension is achieved

• Continue with extension stretches
• Progress to F.W.B. (if this has not already been achieved)
• Check wounds - gentle friction to reduce scar sensitivity
• Commence patellar mobilisations
• R.O.M. exercises - aim to regain full movement equal to opposite leg by 3 weeks
• Progress closed chain exercises (eg: low step-ups)
• Proprioceptive training - balance, etc.

 Progression (as able)

 To include such things as:

• Cycling (free at first) ............................}N.B. ...These are all closed chain
• Step-ups and step-downs ..................} ....exercises which will minimise
• Bouncer ................................................}.....patellofemoral symptoms and
• Single leg balance and exercises .....} ....reduce shearing forces across
• Cliniband - terminal extension ...........}.....the graft
• Abductor and adductor exercises
• Open chain hamstring exercises
• Check scar tissue

When ready progress to:

• Light jogging
• Isokinetic assessment* (at physiotherapist’s discretion)

* When isokinetic assessment is 80% of uninvolved side begin more advanced specific training

 A return to sports specific training, non-contact sport and contact sport is dependant on the individual’s progress and assessment results.

Posterior Cruciate Ligament
The general progression would be as for ACL repair, but avoiding open chain hamstrings in the early stages. Open chain quadriceps exercises are acceptable.

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ANTERIOR CRUCIATE LIGAMENT

Expected Outcome (minimal) and Goals of Achievement

One week post-surgery

Range of movement	0-90 degrees
Gait	Full weight bearing, 75% normal
Balance	Single leg for 30 seconds
Stability	Able to complete 10 x 4” step-ups with good.control

Three weeks’ post-surgery

Range of movement	+ 5 degrees (hyperextension) to 125 degrees
Gait	Full weightbearing, 95% normal
Balance	Single leg for 60 seconds
Stability	Able to complete 10 x 7” step-ups with good control , Able to complete 10 x 20 degree controlled single leg squats

Six weeks’ post-surgery

Range of movement	Full and equal to the opposite side
Gait	Normal
Balance	Equal to the opposite side
Stability	Step-ups and step-downs x 20, with control equal to the opposite side Single leg squats 20 degrees x 20, with control equal to the opposite side

 

 

Nine weeks’ post-surgery

• Able to jog on a trampoline under control
• Progress to functional, non-contact, activities

Twelve weeks’ post-surgery

• Able to jog on a normal surface
• Open kinematic chain quads with minimal weight
• Progress to functional non-contact activities
• Progression to contact sport is dependent upon the sport