Functional Progression After ACL Surgery


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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 (3 months) if isolated ACL reconstruction or 16 weeks with meniscus surgery, micro fracture, or cartilage procedure (check with surgeon for cartilage procedures. 

Minimum Standard Before Progression to Jogging After ACL Reconstruction

  • 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.

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