Rehabilitation after surgical reconstruction focuses on restoring knee range of motion while simultaneously avoiding excessive graft stress until healing has occurred. Specific protocols are highly variable depending on the authors consulted. Most surgeons brace the knee in full extension from a few weeks to 2 months, and most allow early partial or full weight bearing using crutches with the knee in full extension. Range-of-motion (often using a continuous passive motion device) and quadriceps exercises are begun within the first 1 to 4 weeks.1,13,14 In this period, efforts are concentrated on unweighted knee extension exercises and straight leg raises. At 4 to 6 weeks after surgery, the brace is unlocked and closed-chain exercises including biking and leg presses are started, followed by treadmill walking or pool jogging at 3 months. Running is allowed at 5 to 6 months and agility drills at 6 to 7 months. A return to regular sporting activities is anticipated at about 9 months, although some patients may take significantly longer. Return to sports is allowed only after the recovery of normal (90% of contralateral side) quadriceps strength is achieved. Loss of motion may be a problem, and some authors report that as many as 20% of patients require a manipulation under anesthesia 6 to 8 weeks after reconstruction to regain full flexion.9
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