Functional Progression After ACL Surgery | Jeremy M. Burnham, MD

Orthopedic Surgery, Sports Medicine, & Knee Doctor


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Functional Progression After ACL Surgery


The following parameters should serve as a general guideline for functional progression after ACL reconstruction. These guidelines should not replace surgeon and therapist judgement.

When Can I Jog After ACL Surgery?

Clearance for Jogging can be tested at 12 weeks if isolated ligament reconstruction or 16 weeks with Meniscal involvement/bone bruise/microfracture

Minimum Standard

  • 30 Step and Holds without loss of balance or excessive motion outside of the sagittal plane, dynamic valgus, or contralateral pelvic drop
  • 20 consecutive Single Leg Squats to 45°without loss of balance or excessive motion outside of the sagittal plane
  • ≥ 80% 10-RM on the Leg Press/Shuttle
  • No abnormal gait patterns while walking as fast as they can
  • No pain or effusion during or after initiating jogging progression

When Can I do Agility Drills After ACL Surgery?

Clearance for Agility Drills (16 Weeks Minimum for isolated ACL)
Recommend the patient start low-level agility drills if they achieve:

  • 20 consecutive Single Leg Squats to 60° without loss of balance or excessive motion outside of the sagittal plane
  • ≥ 85% 10-Rep Max on the Leg Press/Shuttle
  • Normal running pattern on the treadmill including equal knee flexion in midstance

When Can I Start Jumping After ACL Surgery?

Clearance for Jumping (20 Weeks Minimum for isolated ACL)
Recommend the patient start jumping if they achieve:

  • 10-Rep Max on the Leg Press/Shuttle was ≥ 85%
  • 30 consecutive Single Leg Squats to 60° without loss of balance or excessive motion outside of the sagittal plane
  • 10 Drop vertical lands (13in) with no dynamic valgus and proper trunk control
  • No compensation patterns with deceleration during agility drills (4-Cone Drill)

When Can I Hop and Cut After ACL Surgery?

Hopping and Cutting and Running (24 Weeks Minimum for isolated ACL)
Recommend the patient begin hopping and cutting if they achieve:

  • 10-Rep Max on the Leg Press/Shuttle was ≥ 90%
  • 30 consecutive Single Leg Squats to 60° without loss of balance or excessive motion outside of the sagittal plane while holding ≥ 20% extra weight
  • Noyes hop test equal to 90%
  • 10 Drop Vertical Jumps (13in) with no dynamic valgus and proper trunk control
  • No display of genu valgum when loading into or landing from jumps AND equal weight distribution when initiating and landing the jumps

References:

  1. Della Villa S, Boldrini L, Ricci M, et al. Clinical Outcomes and Return-to-Sports Participation of 50 Soccer Players After Anterior Cruciate Ligament Reconstruction Through a Sport-Specific Rehabilitation Protocol. Sports Health. 2012;4(1):17–24. doi:10.1177/1941738111417564
  2. Nawasreh Z, Logerstedt D, Cummer K, Axe M, Risberg MA, Snyder-Mackler L. Functional performance 6 months after ACL reconstruction can predict return to participation in the same preinjury activity level 12 and 24 months after surgery. Br J Sports Med. 2018 Mar;52(6):375. doi: 10.1136/bjsports-2016-097095. Epub 2017 Sep 27. PubMed PMID: 28954801; PubMed Central PMCID: PMC5834373.