It is important to regain full ROM by 4-6 weeks post-operatively. Most protocols agree with this. In some cases, ROM may be limited early depending on physician's protocol. But it is important to establish full motion especially into extension by 4-6 weeks post-operatively. ROM exercise may include heel prop, heel slide, wall slide, etc. Stretching calf and hamstring muscles will help to regain knee extension.
2) Quadriceps Straightening
Quadriceps strengthening can be initiated as soon as inflammation is controlled. Initially quad sets with or without NMES(neuromuscular electrical stimulation) is a good way to start firing quad muscle and it can be progressed to straight leg raises (only if knee extension is maintained during exercise). Strengthening exercises for other muscles can also be initiated. It is important to follow physician's protocol and to protect reconstructed graft.
3) Gait
Normal gait should be established as the injured athlete can tolerate. If he/she can't walk normally, they should be placed on the crutches. Weight shift exercise and gait training on treadmill can help to re-establish normal gait as well as walking in a pool.
4) Strengthening (closed kinetic chain)/balance exercise
CKC strengthening exercise can be initiated later in this phase of rehab. It includes partial squat, wall squats, leg press, single leg balance, TKE, etc. Again each physician has their own protocol, so it is important to follow it.
The goals of this phase of rehab will be 1) regain full ROM, 2) establish normal gait, 3) start strengthening exercises that include CKC exercise and balance training. Also, strengthening training should be pain-free and inflammation should be under control.
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