Postoperative
Rehabilitation
Protocolfor Anterior
Cruciate
Ligament
Reconstruction
NOBUTOKITAMURA NOBUTOKITAMURA NOBUTOKITAMURANOBUTOKITAMURANOBUTO KITAMURANOBUTO(NK)KITAMURA
Postoperative
Bracing
Rangeofmotion
Weightbearing
Exercises
NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA
periodDay
1- Use knee
fullpassive NOBUTO- Protected
1. Ankle
pumps NOBUTO KITAMURANOBUTOKITAMURANOBUTOKITAMURA - Obtain
NOBUTOKITAMURAKITAMURA NOBUTOKITAMURAimmobilizer
extension (0°) out ofweightat 10-30°ofimmobilizer(essential)NOBUTO
bearingwith NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTOKITAMURANOBUTO KITAMURAKITAMURA
knee flexion
crutches
NOBUTOKITAMURANOBUTOKITAMURADay
2 -6- Use aKITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO
1. Ankle
pumps NOBUTO KITAMURA
functional
2. Straightleg raises
Day
7 -13
- Weight
bear NOBUTONOBUTOKITAMURANOBUTOKITAMURA NOBUTO KITAMURA NOBUTOKITAMURAKITAMURANOBUTO KITAMURAknee brace
3. Side lying(Week 2)
as toleratedabduction/adduction
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURA NOBUTO KITAMURA
4. Prone hip extension
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURANOBUTO KITAMURA
5. Quadsets
Day14-27
Continuepassive
1-5
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA(Week 3-4)
extension to 0°
6. Knee extension with bandassistedknee NOBUTO KITAMURA NOBUTO(range:90 → 70°
knee KITAMURANOBUTO KITAMURA NOBUTO KITAMURA - Active
NOBUTOKITAMURAKITAMURANOBUTOflexionflexion)
NOBUTO KITAMURA NOBUTO KITAMURA (Goal:NOBUTOKITAMURAKITAMURANOBUTO KITAMURA90°of flexion) NOBUTO KITAMURA NOBUTO
7. Staticsquats (bodyweight)
Week
5-6
Achievefullextension
1-7
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA- Active assisted knee
8. Hamstring curls with band
NOBUTO KITAMURA NOBUTO KITAMURA flexion
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURANOBUTO(range:45 → 90°
knee KITAMURA(Goal: 120° of flexion)
flexion)NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURANOBUTO KITAMURA
9. Half-squat(bodyweight,range:30 to 90°NOBUTOknee flexion)
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURAKITAMURAWeek 7-83-9NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURANOBUTO
10. Biking
as toleratedto 30KITAMURAminutes (low resistance)
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURANOBUTO KITAMURA
11. Standingcalf raises
with/without
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURA support
NOBUTO KITAMURA
12. Step-ups 2-4"
NOBUTOKITAMURANOBUTOKITAMURA - Achieve
NOBUTO passive
KITAMURANOBUTO KITAMURA NOBUTOWeek
9-12- Gait withoutflexion
8-12 KITAMURA NOBUTO KITAMURAbracingto 140°
13. Knee extension with band
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURANOBUTO(range:90 → 30°
knee KITAMURAflexion)
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURA NOBUTO KITAMURA
14. Step-ups 6-8”
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURANOBUTO KITAMURA
15. Quickwalk
Week
13-1410-15NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA
16. Half-squat (10 to 90° kneeflexion)
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURA NOBUTO KITAMURA
17. Single-leg squat with support
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURAKITAMURA
18. Legpress (10 NOBUTOto 90° kneeflexion)
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA
19. Hamstring curls with band(range:10 → 90°knee KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURANOBUTOflexion)
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURANOBUTO KITAMURA
20. Poolwalking (+swimming:flutterkick only)NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURAWeek 15-1610-13, 16-20
21. SplitsquatNOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURANOBUTO KITAMURA
22. Lunge
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURA NOBUTO
23. Treadmill/Jogging(level KITAMURA
surfaces
only, straight
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURANOBUTOline),KITAMURA
100m x 10Week
17-20 NOBUTO KITAMURA - Achieve
full flexion
13, 16-21
NOBUTOKITAMURANOBUTO near
KITAMURANOBUTO KITAMURA NOBUTOKITAMURA NOBUTO KITAMURA
24. Jogging* 20 minutes at 10NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURA12km/h,2 sets NOBUTO KITAMURA
25. Balancedrills* NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURAWeek 21-24
13, 16-21, 24, 25NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTOKITAMURANOBUTO KITAMURA
26. Gaitdrills*Week 25-28
13, 16-21NOBUTO KITAMURA NOBUTO(6 months---)1
27. Jogging/running (no limits)
28. Agility drills*
29. Landing drills*
Week 29 --30. Return to sport skills on own
at practice with minimal riskof re-injury2
1. Quadriceps/thigh circumference should be within 1 cm of nonoperative side at 6 months.
2. No competitive or pivot sports until cleared by surgeon.

*Jogging in the park or athletic field-Before starting running drills, check if complete single leg sit-to-stand-to-sit sequence is achieved (single leg sit-tostand test or chair stand test).
Start slowly and progress to the next level only if there is no pain, swelling or instability.
[Week 1] Day 1: Jogging (level surfaces only, straight line) 100m x 2
Jogging 300-400m in a clockwise direction and 300-400m in a counter-clockwise direction
Day 2: Jogging 500-600m in a clockwise direction and 500-600m in a counter-clockwise direction
Day 4: Jogging 800m in a clockwise direction and 800m in a counter-clockwise direction
Day 6: Jogging 1000m in a clockwise direction and 1000m in a counter-clockwise direction[Week 2～]Jogging 20 minutes at 10-12km/h, 1-2 sets

*Balance drills
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA- Single leg balance, eyes closed- Singleleg balance,arms
side-to-side
NOBUTOKITAMURANOBUTOKITAMURANOBUTO KITAMURA- Single leg balance, trunk flexion/extension
NOBUTOKITAMURANOBUTOKITAMURANOBUTO KITAMURA- Singleleg balance,
angulartrunk flextion/extension- Single leg balance, leg forward/side/backNOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA*GaitKITAMURAdrillsNOBUTONOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURASide stepNOBUTO- KITAMURALunge walk NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURACross stepNOBUTOKITAMURA- KITAMURASide step in NOBUTOmini squatposition NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA- KITAMURAForward zig-zagskater’sstepNOBUTONOBUTOKITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURABackward zig-zag skater’s stepNOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA*Agilitydrills
NOBUTO- KITAMURAFigure 8’s NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA- KITAMURABackward jogNOBUTONOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURAAcceleration/deceleration/sprints
NOBUTO- KITAMURAShuttle runs NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURAZig-zag runningNOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURALadder drillNOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA*Landing drills
NOBUTONOBUTO- KITAMURA
Step offs, bothlegs KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA
Step offs, single leg
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA
Box jump- KITAMURA
Leap & landNOBUTO(single legjump→ Pauseand KITAMURA
hold your balancein thispartial squat
positionfor 2-3 seconds)
NOBUTOKITAMURANOBUTONOBUTOKITAMURANOBUTOKITAMURANOBUTO KITAMURAJump stops (Perform three forward jumps, with both legs, then stop. Maintain good balance in a squat position forNOBUTO3-4KITAMURAseconds) NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURABounce jumpsNOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTOKITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA
Note:(1) There
may beslight variations
this protocol
if there NOBUTO
are limitations
imposedfrom associatedsuchas
NOBUTOKITAMURANOBUTOKITAMURAin NOBUTOKITAMURAKITAMURANOBUTOKITAMURA injuries
NOBUTOKITAMURA
meniscal tears, cartilage injuries, or other ligamentous injuries.
NOBUTOKITAMURANOBUTOKITAMURA NOBUTOKITAMURANOBUTObecause
KITAMURANOBUTO KITAMURAKITAMURA(2) This
protocol must
be individualized
for optimal
return to activity
an individual’s
progress isNOBUTOvariable.
NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURA NOBUTO KITAMURANOBUTO KITAMURA NOBUTO