It is important to understand that every person goes through the ACL protocol at their own pace and allows the criteria to determine their progress, an ACL guide is not a pre-determined timeline.
1. RECOVERY FROM SURGERY
Get the knee straight (full extension) - by WEEK 4
Settle the swelling down to ‘mild’
Get the quadriceps fired again
Regular icing of the knee and graft donor site (usually hamstring or patellar tendon)
Compression of knee + lower limb
Basic quadriceps setting exercises + gentle range of motion exercises to improve knee extension & flexion
2. STRENGTH AND NEUROMUSCULAR CONTROL
Regain most muscle strength
Regain most of balance
Single-leg squat with good technique and alignment
Commence with easy bodyweight exercises, progress into resistance, balance, and coordination
*Important*: listen to the knee – increase in pain and/or swelling, 2 main symptoms knee is not tolerating workload
Lunges, step-ups, squats, bridging, calf raises, hip abduction strengthening, core exercises, balance, gait re-education drills, non-impact aerobic conditions (cycling, swimming, walking)
3. RUNNING, AGILITY & LANDING
Score ‘excellent’ on a jump-rebound task
Progress successfully through an agility program
Regain full strength & balance
Return of running, agility, jumping + hopping, the continuation of gym-based strength + neuromuscular program
Knee should be free of swelling + pain
Emphasize correct technique, especially deceleration tasks
Agility drills – slalom running, shuttle runs, ladder drills, etc.
Jumping exercises start with scissor jumps, single leg hops. Progress to box jumps + single leg landings w perturbation.
Important there’s one rest + recovery time
4. RETURN TO SPORT
Successful completion of Melbourne Return to Sports Score (95)
The athlete is comfortable, confident, and eager to return to sport
ACL injury prevention program is discussed, implemented, and continued whilst the athlete is participating in sport
Highly individualized, exercises + training activities would normally be integrated into their regime
Focus on getting the person ready for sport, not just the knee
Knee needs to be stable & strong, with optimal neuromuscular patterning and biomechanics.
The athlete needs to be confident and mentally ready to return
5. PREVENTION OF RE-INJURY
Successful ACL injury prevention programs include:
Plyometric, balance, and strengthening exercises
Program must be performed more than once per week
Program continues for at least 6 weeks
Most ACL injuries + re-injuries occur in non-contact situations with either cutting movement or one-legged landing
ACL injury prevention programs aim to train safer neuromuscular patterns during tasks
Females have a higher risk of ACL injury (x2-8) compared to males who undertake same sport or activity