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Day 1 : Patient is put in a long knee brace. Drain removal on days 2 with dressing.

Exs. : Ankle exs. - move your feet up & down & round (Clockwise & anti Clockwise)

1st Week - Rest, Immobilization (with use of long brace) & Elevation.

0-7 Days : Strictly non weight bearing walking with crutches - to review in OPD in 10 days for suture removal.

Long sitting position of patient - holding a cloth / tight elastic material placed under the forefoot pushes the foot down towards floor against the resistance of the material.

Patient pushes the foot against the wall.

Exs.

Ankle exs. - same as above
Ankle Pump exs.

Knee Exs.

Static quadriceps - press down both knees on the floor hold for 5 sec. & relax (50 - 100 times / 4 times a day)
Knee bending 0 - 30⁰ - slowly bend the knee till 30⁰ in lying position by dragging the hill.

Static Glutei

Tighten / pull in your buttocks hold for 5 sec. & relax.
Keeping pillow in between legs, press the pillow tight inside with knee straight for 5 sec. relax.

2nd Week - Non wt. bearing with Crutches Continues

7-14 Days :

Ankle Exs. - Same as Below
Knee Exs. - (Knee Bending 30⁰ - 60⁰)

In lying position / sitting position start bending knee unto 60⁰.
Lie on stomach (prone posin) - start bending the knee till 60⁰ with and without support of other ( Normal) leg.
Sitting at the edge of the bed - with the support of the other leg (keep the other leg down the ankle for support) slowly bends the knee 60⁰. Also try to straighten the knee & without support.

Static Quatdriaps - to continue.
Straight leg raising exs - In lying down position raise your leg keeping knee straight, hold for 5 sec. & slowly bring it down ( keeping knee straight ) [If patient cannot raise the leg by himself ask other person to hold the leg & then do the same.

In lying down position raise the leg keeping the straight in the air ( Just above the bed ) & then slowly take the leg outward (away from the other leg) till 40⁰ , hold for 5 sec. then bring it to normal position. (If patient cannot raise the leg straight in the air, then without lifting the leg from the bed / floor, drag the knee outward)

VMO Exs.

In lying / sitting position keep pillows below the knee so that knees are 30⁰ - 40⁰ bending. Patient try to straighten (extend) the knee, hold for 5 sec. & relax.
In lying down position - tilt the turn leg 10 - 15⁰ outward , then keeping the knee straight , lift the leg up (40 ⁰ - 45⁰) then move the leg outward & inwards, bring it in the centre & then bring the leg down.

3rd Week - Continue Non wt. Bearing Walking with Cruches.

14-21 Days - Conti. All above exs.

Knee bending (60⁰ - 90⁰) - Repeat same exs as for bending the knee till 90⁰ with and without support of other leg.

While sitting at the edge of a bed / chair Hold the knee straight for 5 Sec. & then bend the knee. While straightening the knee, keep the weight of other (N) leg on the affected leg and resist or tie weight unto. ( ½ kg. to 2 kgs.)

Lying on stomach (Hamstring strengthening exs) while bending the knee keep the weight. Of other ( N) leg on affected leg & resist the bending or tie weight cuffs ( ½ to .. 2 kgs.) & do the exs.
Hams strengthening in standing - hold to the support in front & bend the affected knee (take heel towards buttocks) & then lower it. * ( Do not touch the affected foot on the ground).

Abduction against gravity - lie side ways with normal site down. Raise the affected leg upward ( keeping the knee straight.) upto 40⁰ - 45⁰ hold for 5 sec. & bring it down.

4th Week (21- 30 Days) - Continue With Non wt. Bearing Crutch Walking

Knee bending 90⁰ - 120⁰ cont. same exs. as above

While knee bending in prone posin (lying on stomach) or in sitting at the edge of bed, slowly force with the other leg to achieve the desired bending.

Quadriceps Strengthening
- In lying position while lifting leg straight upwards tie wt.( ½ - 2 kgs.) & do exs.
- Same exs while sitting at the edge of the bed. (With tying wt.
Bicycling in the air - lie on the bed on the back, slowly bend the knee & do cycling in the air.

4th Week Onwards

As per Doctor’s advise, walk without crutches. ( full wt. bearing ) Same exs to be continue with progressive increase in wts. For strengthening of Hams & Quadriceps muscles.

Wt. Bearing Exs.

½ to full squats can be added, with & then with out holding the support in front.

Sitting down & getting up from the chair / stool.
Standing on toes & walking without support.
Standing with back against the wall. Place a firm pillow between knees. Slice down (60⁰) & while sliding down squeeze the pillow as hard as you can.

Partial & full lunges - patient stand with one leg forward. Then rock the body weight forwards, allowing to bend the knee slightly & then rock backwards with knee straight. ( do not bend knee for beyond the toes).

For Progression -

Increase the dist between two legs (stride length).
Knee bending according. Weights can be added in the pat’s hand for progressive strengthening. The speed of the activity is also increased as control improves.

Forward, backward & lateral steps ups & downs begin with low step 2-3 inches in ht. & increase the height progressively. [ pat should keep the trunk upright step up the (low) stool by putting the affected leg 1 st & then climb down on the other side by putting the healthly leg forward.
Theraband Exs - shown in chart

Disclaimer : This is the protocol followed by Dr. Archik and every surgeon can have a different protocol. Please consult your own surgeon if you have undergone a recent surgery for ACL reconstruction.