JPD Acl Protocol Moon VSM

MOON ACL Rehabilitation Guidelines
M.O.O.N.
Team
Multicenter
Orthopaedics
Outcomes
Network
M.o.o.n. Team
members
General Information: The following ACL rehabilitation guidelines

are based on a review of the randomized controlled trials related to
ACL rehabilitation. For many aspects of ACL rehabilitation there are
either no studies that qualify as best-evidence or the number of
studies is too few for conclusions to be drawn with confidence. In
these circumstances, the recommendations are based upon the guidance
of the MOON panel of content experts.
The guidelines have been developed to service the spectrum of ACL
injured people (non-athlete elite athlete). For this reason, example
exercises are provided instead of a highly structured rehabilitation
program. Attending rehabilitation specialists should tailor the
program to each patients specific needs.
The multi-center nature of the MOON group necessitates that the
MOON ACL Rehabilitation Program only include treatment methods
that can be employed at all sites without purchasing expensive
equipment. Consequently, some treatment methods with supporting
evidence (e.g., using a high-intensity electric stimulation training
program for strength, aquatic therapy) are not included in the program
because the expert panel believed that it is unreasonable to expect all
sites to carry out such treatments.
Progression from one phase to the next is based on the patient
demonstrating readiness by achieving functional criteria rather than
the time elapsed since surgery. The timeframes identified in
parentheses after each Phase are approximate times for the average
patient, NOT guidelines for progression. Some patients will be ready
to progress sooner than the timeframe identified, whereas others will
take longer.
The recommended number of visits to the rehabilitation specialist
(including visits merely for evaluation / exercise progression) is 16 to
24 visits with the majority of the visits occurring early (BIW x 6
weeks). However, it is recognized that some patients health plans are
severely restrictive. For this reason, the minimum number of post-ACL
reconstruction visits to a rehabilitation specialist has been set at 6 visits
for the MOON group patients.
If there are any questions regarding the MOON ACL Rehabilitation
Guidelines, then please contact Dr. _____________________________
or the Sports Medicine Centers Rehabilitation Liaison:
_______________________________________________.
ACL Rehabilitation Guidelines
Phase 0: Pre-operative Recommendations

Normal gait
AROM 0 to 120 degrees of flexion
Strength: 20 SLR with no lag
Minimal effusion
Patient education on post-operative exercises and need for
compliance
Educated in ambulation with crutches
Wound care instructions
Educated in MOON follow-up expectations
PHASE 1: Immediate Post-operative Phase (Approximate
timeframe: Surgery to 2 weeks)
GOALS
M.O.O.N.
Group
Multicenter
Orthopaedics
Outcomes
Network
Full knee extension ROM

Good quadriceps control (> 20 no lag SLR)
Minimize pain
Minimize swelling
Normal gait pattern
Crutch Use: WBAT with crutches (beginning the day of surgery)

Crutch D/C Criteria: Normal gait pattern
Ability to safely ascend/descend stairs without
noteworthy pain or
Instability (reciprocal stair climbing)
Knee Immobilizer: None (Exception: First 24 hours after a femoral
nerve block)
Cryotherapy: Cold with compression/elevation (e.g. Cryo-cuff, ice
with compressive stocking)
First 24 hours or until acute inflammation is controlled: every
hour for 15 minutes
After acute inflammation is controlled: 3 times a day for 15
minutes
Crushed ice in the clinic (post-acute stage until D/C)
EXERCISE SUGGESTIONS
ROM
Extension: Low load, long duration (~5 minutes) stretching

(e.g., heel prop, prone hang minimizing co-contraction and
nocioceptor response)
2
M.O.O.N.
Group
Multicenter
Orthopaedics
Outcomes
Network
Flexion: Wall slides, heel slides, seated assisted knee flexion,

bike: rocking-for-range
Patellar mobilization (medial/lateral mobilization initially
followed by superior/inferior direction while monitoring
reaction to effusion and ROM)
Muscle Activation/Strength
Quadriceps sets emphasizing vastus lateralis and vastus
medialis activation
SLR emphasizing no lag
Electric Stimulation: Optional if unable to perform no lag
SLR
Discontinue use when able to perform
20 no lag SLR
Double-leg quarter squats
Standing theraband resisted terminal knee extension (TKE)
Hamstring sets
Hamstring curls
Side-lying hip adduction/abduction (Avoid adduction moment
in this phase with concomitant grade II III MCL injury)
Quad/ham co-contraction supine
Prone Hip Extension
Ankle pumps with theraband
Heel raises (calf press)
Cardiopulmonary
UBE or similar exercise is recommended
Scar Massage (when incision is fully healed)

CRITERIA FOR PROGRESSION TO PHASE 2
20 no lag SLR
Normal gait
Crutch/Immobilizer D/C
ROM: no greater than 5 active extension lag, 110 active
flexion
PHASE 2: Early Rehabilitation Phase (Approximate timeframe:

weeks 2 to 6)
GOALS
Full ROM
Improve muscle strength
Progress neuromuscular retraining
3
ROM
Low load, long duration (assisted prn)

Heel slides/wall slides
Heel prop/prone hang (minimize co-contraction / nociceptor
response)
Bike (rocking-for-range riding with low seat height)
Flexibility stretching all major groups
Strengthening
M.O.O.N.
Group
Multicenter
Orthopaedics
Outcomes
Network
Quadriceps:
Quad sets
Mini-squats/wall-squats
Steps-ups
Knee extension from 90o to 40o
Leg press
Shuttle Press without jumping action
Hamstrings:
Hamstring curls
Resistive SLR with sports cord
Other Musculature:
Hip adduction/abduction: SLR or with equipment
Standing heel raises: progress from double to single leg support
Seated calf press against resistance
Multi-hip machine in all directions with proximal pad
placement
Neuromuscular training
Wobble board
Rocker board
Single-leg stance with or without equipment (e.g. instrumented
balance system)
Slide board
Fitter
Cardiopulmonary
Bike
Elliptical trainer
Stairmaster
4

Full ROM
Minimal effusion/pain
Functional strength and control in daily activities
IKDC Question # 10 (Global Rating of Function) score of > 7
(See page 9)
PHASE 3: Strengthening & Control Phase (Approximate timeframe:

weeks 7 through 12)
GOALS
Maintain full ROM

Running without pain or swelling
Hopping without pain, swelling or giving-way
M.O.O.N.
Group
Multicenter
Orthopaedics
Outcomes
Network
Strengthening
Squats
Leg press
Hamstring curl
Knee extension 90o to 0o
Step-ups/down
Lunges
Shuttle
Sports cord
Wall squats
Neuromuscular Training
Wobble board / rocker board / roller board

Perturbation training
Instrumented testing systems
Varied surfaces
Cardiopulmonary
Straight line running on treadmill or in a protected environment

(NO cutting or pivoting)
All other cardiopulmonary equipment
Running without pain or swelling
Hopping without pain or swelling (Bilateral and Unilateral)

Neuromuscular and strength training exercises without
difficulty
PHASE 4: Advanced Training Phase (Approximate timeframe:

weeks 13 to 16)
GOALS
M.O.O.N.
Group
Multicenter
Orthopaedics
Outcomes
Network
Running patterns (Figure-8, pivot drills, etc.) at 75% speed

without difficulty
Jumping without difficulty
Hop tests at 75% contralateral values (Cincinnati hop tests:
single-leg hop for distance, triple-hop for distance, crossover
hop for distance, 6-meter timed hop)
Aggressive Strengthening
Squats
Lunges
Plyometrics
Agility Drills
Shuffling
Hopping
Carioca
Vertical jumps
Running patterns at 50 to 75% speed (e.g. Figure-8)
Initial sports specific drill patterns at 50 75% effort
Neuromuscular Training
Wobble board / rocker board / roller board

Perturbation training
Instrumented testing systems
6
Varied surfaces
Cardiopulmonary
Running
Other cardiopulmonary exercises
Maximum vertical jump without pain or instability

75% of contralateral on hop tests
Figure-8 run at 75% speed without difficulty
IKDC Question # 10 (Global Rating of Knee Function) score of
> 8 (See page 9)
PHASE 5: Return-to-Sport Phase (Approximate timeframe: weeks

17 to 20)
GOALS
M.O.O.N.
Group
Multicenter
Orthopaedics
Outcomes
Network
85% contralateral strength

85% contralateral on hop tests
Sport specific training without pain, swelling or difficulty
Aggressive Strengthening
Squats
Lunges
Plyometrics
Sport Specific Activities
Interval training programs

Running patterns in football
Sprinting
Change of direction
Pivot and drive in basketball
Kicking in soccer
Spiking in volleyball
Skill / biomechanical analysis with coaches and sports medicine
team
RETURN-TO-SPORT EVALUATION RECOMMENDATIONS:
Hop tests (single-leg hop, triple hop, cross-over hop, 6 meter

timed-hop)
Isokinetic strength test (60/second)

Vertical jump
Deceleration shuttle test
MOON outcomes measure packet (mandatory; should be
completed post-testing)
RETURN-TO-SPORT CRITERIA:
M.O.O.N.
Group
Multicenter
Orthopaedics
Outcomes
Network
No functional complaints
Confidence when running, cutting, jumping at full speed
85% contralateral values on hop tests
IKDC Question # 10 (Global Rating of Knee Function) of > 9
(See page 9)
IKDC Question #10

How would you rate the function of your knee on a scale of 0
to 10 with 10 being normal, excellent function and 0 being
the inability to perform any of your usual daily activities
which may include sports?
CURRENT FUNCTION OF YOUR KNEE:
Cannot perform
Daily activities
0
No Limitation
4
M.O.O.N.
Group
Multicenter
Orthopaedics
Outcomes
Network
10

JPD Acl Protocol Moon VSM

Uploaded by

Copyright:

Available Formats

JPD Acl Protocol Moon VSM

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

JPD Acl Protocol Moon VSM

Uploaded by

Copyright:

Available Formats

MOON ACL Rehabilitation Guidelines

General Information: The following ACL rehabilitation guidelines

ACL Rehabilitation Guidelines

Phase 0: Pre-operative Recommendations

Full knee extension ROM

Crutch Use: WBAT with crutches (beginning the day of surgery)

Extension: Low load, long duration (~5 minutes) stretching

ACL Rehabilitation Guidelines

Flexion: Wall slides, heel slides, seated assisted knee flexion,

UBE or similar exercise is recommended

Scar Massage (when incision is fully healed)

PHASE 2: Early Rehabilitation Phase (Approximate timeframe:

ACL Rehabilitation Guidelines

Low load, long duration (assisted prn)

ACL Rehabilitation Guidelines

PHASE 3: Strengthening & Control Phase (Approximate timeframe:

Maintain full ROM

Wobble board / rocker board / roller board

Straight line running on treadmill or in a protected environment

ACL Rehabilitation Guidelines

CRITERIA FOR PROGRESSION TO PHASE 4

Running without pain or swelling

Hopping without pain or swelling (Bilateral and Unilateral)

PHASE 4: Advanced Training Phase (Approximate timeframe:

Running patterns (Figure-8, pivot drills, etc.) at 75% speed

Wobble board / rocker board / roller board

ACL Rehabilitation Guidelines

CRITERIA FOR PROGRESSION TO PHASE 5

Maximum vertical jump without pain or instability

PHASE 5: Return-to-Sport Phase (Approximate timeframe: weeks

85% contralateral strength

Sport Specific Activities

Interval training programs

ACL Rehabilitation Guidelines

RETURN-TO-SPORT EVALUATION RECOMMENDATIONS:

Hop tests (single-leg hop, triple hop, cross-over hop, 6 meter

Isokinetic strength test (60/second)

ACL Rehabilitation Guidelines

IKDC Question #10

You might also like