Rehabilitation Protocols

May 23, 2025

Rehabilitation Protocols

Evidence-based rehabilitation approaches for optimal recovery.

Core Principles of ACL Rehabilitation

Modern ACL rehabilitation is guided by several evidence-based principles:

Criterion-based progression: Advancing based on achieving specific milestones rather than strict time frames
Neuromuscular training: Focusing on quality of movement and motor control, not just strength
Addressing the entire kinetic chain: Including hip, core, and ankle function, not just the knee
Psychological readiness: Recognizing the importance of confidence and reduced fear of re-injury
Individualization: Tailoring protocols to patient-specific factors including graft type, concomitant injuries, and goals

Early vs. Accelerated Rehabilitation

Contemporary protocols vary in their approach to early rehabilitation:

Traditional protocols: More conservative approach with delayed weight-bearing and restricted range of motion
Accelerated protocols: Earlier weight-bearing, range of motion, and strengthening based on research showing benefits for graft healing and reduced complications
Current consensus: Most surgeons now recommend early controlled motion and progressive weight-bearing, but protecting the graft from excessive strain during early healing phases

Key Rehabilitation Components

Comprehensive programs typically include:

Range of motion restoration: Early emphasis on achieving full extension and progressive flexion
Strength development: Progressive resistance training for quadriceps, hamstrings, gluteals, and core
Neuromuscular control: Exercises focusing on balance, proprioception, and coordination
Gait retraining: Correcting compensatory movement patterns
Cardiovascular conditioning: Maintaining fitness through appropriate activities
Plyometric training: Developing power and reactive strength
Sport-specific training: Gradually introducing movements and scenarios from the patient’s sport or activity

Specialized Approaches

Different patient populations may require tailored protocols:

Athletes: More aggressive protocols with sport-specific training
Adolescents: Consideration for growth plates and higher risk of re-injury
Older adults: Focus on functional activities and quality of life
Multi-ligament injuries: Modified protocols based on associated injuries

Expectations

This is repeated in another article here as well, but it bears repeating. Note that you may read about or hear of those who are getting up and about almost immediately whereas others aren’t really walking yet in a month or more. Everyone is different and may have had different experiences. That is, different ages, different injury levels, different surgical procedures, different amounts of time between injury and surgery with opportunity to prep for surgery, and so on. It’s natural to want to have some baselines and a desire to have some expectations. Just understand that your journey will be your own. You’ll do what you can when you can; just be sure to do so safety with guidance from your care team.