ACL Reconstruction Protocol

Name: ACL Reconstruction Protocol
Creator: HEP Drop

ACL rehab protocol after reconstruction, by week to 12 months: phases, brace and weight bearing, graft and meniscus repair options, test gates for running and return to sport, with cited sources and a free printable PDF.

By HEP Drop staff · Reviewed by a licensed physical therapist, Oct 2026 · Version 2026.10 · 29 sources · How we write protocols

Written for adults. For athletes aged 10 to 18, an international consensus is stricter: more than 95% symmetry, and rehab to 12 months for younger athletes^[5].

At a glance (Patellar tendon autograft): WBAT with crutches from day 0 · brace only if prescribed · full extension by wk 2 · open chain 90–45° from wk 4, full range from wk 12 · running from wk 12 once the criteria are met · pivoting sport from 9 mo. Criteria-based, test-gated.

Timeline

Currently showing: Patellar tendon autograft · Version 2026.10

Timeline, weeks 0–52 after surgery. Select any bar for details. Key dates are also in the key milestones table.

Phase

Weight bearing

Brace (if prescribed)

Motion

Strength

Care

Restrictions

Milestones

Phase 1 · Protect and extend

wk 0–2

CPM is not used^{[1, 10]}.

Goals

Full passive extension, equal to the other knee^{[7, 6]}
Quadriceps activation: a straight leg raise without lag^[7]
Effusion and pain control^[1]
Weight bearing as tolerated with crutches, unless the surgeon restricts it^[1]

Allowed

Knee motion and weight bearing from the first week^[1]
Quad sets with NMES, started in week 1^{[12, 1]}
Self patellar mobilization in the home program^[7]
Patellar tendon graft: patellar mobilization emphasized, and watch for patellar tendon pain during quadriceps loading^{[15, 7]}
Heel props or prone hangs if extension is not full^{[5, 7]}

Avoid

Open-chain knee extension past 45° (none before wk 4) (until wk 12)
Driving, until emergency braking is safe (until wk 6)
Pool work until the wound has fully healed (about wk 3–4)^[1]

Advance to Phase 2 when

Full passive knee extension, equal to the other knee^{[7, 6]} (yes/no check) test: Knee ROM
Straight leg raise without extension lag^{[7, 6]} (yes/no check) test: SLR, no lag
Effusion 1+ or less on the modified stroke test^[7] (yes/no check) test: Stroke test

Exercises

Quad Set2–3 × 10–15 (sets/reps: our default)See it in HEP Drop →

Active Straight Leg Raise with Quad Set, start

Active Straight Leg Raise with Quad Set, finish

Active Straight Leg Raise with Quad Set2–3 × 10–15 (sets/reps: our default)See it in HEP Drop →

Ankle Pumps2–3 × 10–15 (sets/reps: our default)See it in HEP Drop →

Seated Knee Extension Stretch (Heel Prop), start

Seated Knee Extension Stretch (Heel Prop), finish

Seated Knee Extension Stretch (Heel Prop)10 min with no weight, then add weight and timeSee it in HEP Drop →

Prone Knee Extension Overpressure (Prone Hang), start

Prone Knee Extension Overpressure (Prone Hang), finish

Prone Knee Extension Overpressure (Prone Hang)10 min with no weight, then add ankle weight and timeSee it in HEP Drop →

Supine Heel Slide2–3 × 10–15 (sets/reps: our default)See it in HEP Drop →

Wall Slide (Hook-Lying)2–3 × 10–15 (sets/reps: our default)See it in HEP Drop →

Standing Calf Raise2–3 × 10–15 (sets/reps: our default)See it in HEP Drop →

How protocols differ: The compared protocols end their first stage at wk 2, wk 3 or wk 6^{[27, 26, 28]}.

Create HEP for Phase 1 →Match the surgeon's protocol →Opens HEP Drop · Free during early access

Key milestones by week

How this protocol compares with published ACL reconstruction protocols, on a shared week scale (pivoting sport on a 12-month scale). Criteria-based: advance only when each phase's criteria are met.

Want the patient's dates here? (or weeks post-op).

This protocol vs published protocols · Patellar tendon autograft
Milestone	This protocol	0816243252 wk Range in published protocols	Published range
Brace off	wk 4		wk 4–6^{[26, 27, 28]}two of three at about wk 6
Open chain 90–45°	wk 4		early post-op to wk 8^{[26, 27, 28]}two of three at wk 6
Open chain, full range	wk 12		wk 12 to 4 mo^{[26, 28]}two give a week: wk 12 and 4 mo
Running	wk 12		3 to 5 mo^{[26, 27, 28]}all three include 4 mo
Pivoting sport	from 9 mo	months scale: 0–12 mo	9–12 mo^{[27, 28]}two of three at 9–12 mo; one gives no month

Range in published protocolsMost commonThis protocol

All phases

⬇ Download PDFDownload PDF / Print protocol: your clinician copy, no email needed. Create HEP: a patient handout in HEP Drop with that phase's exercises prefilled. Opens HEP Drop · Free during early access.

Phase 1 · Protect and extend

wk 0–2Create HEP for Phase 1 →

Allowed

Knee motion and weight bearing from the first week^[1]
Quad sets with NMES, started in week 1^{[12, 1]}
Self patellar mobilization in the home program^[7]
Patellar tendon graft: patellar mobilization emphasized, and watch for patellar tendon pain during quadriceps loading^{[15, 7]}
Heel props or prone hangs if extension is not full^{[5, 7]}

Avoid

Open-chain knee extension past 45° (none before wk 4) (until wk 12)
Driving, until emergency braking is safe (until wk 6)
Pool work until the wound has fully healed (about wk 3–4)^[1]

Exercises

Quad Set2–3 × 10–15 (sets/reps: our default)

Active Straight Leg Raise with Quad Set2–3 × 10–15 (sets/reps: our default)

Ankle Pumps2–3 × 10–15 (sets/reps: our default)

Seated Knee Extension Stretch (Heel Prop)10 min with no weight, then add weight and time

Prone Knee Extension Overpressure (Prone Hang)10 min with no weight, then add ankle weight and time

Supine Heel Slide2–3 × 10–15 (sets/reps: our default)

Wall Slide (Hook-Lying)2–3 × 10–15 (sets/reps: our default)

Standing Calf Raise2–3 × 10–15 (sets/reps: our default)

Advance to Phase 2 when

Full passive knee extension, equal to the other knee^{[7, 6]} (yes/no check) test: Knee ROM
Straight leg raise without extension lag^{[7, 6]} (yes/no check) test: SLR, no lag
Effusion 1+ or less on the modified stroke test^[7] (yes/no check) test: Stroke test

Phase 2 · Motion and gait

wk 2–6Create HEP for Phase 2 →

Allowed

Open-chain knee extension in 90–45° from wk 4^[1]
Stationary bike for motion^{[7, 5]}
Open and closed chain strength together, and balance^[1]
Blood flow restriction training, optional^{[1, 13]}

Avoid

Open-chain knee extension past 45° (none before wk 4) (until wk 12)
Driving, until emergency braking is safe (until wk 6)
Pool work until the wound has fully healed (about wk 3–4)^[1]

Exercises

Seated Long Arc Quad90–45° only, 3 × 12–20 RM · from wk 4

Standing Mini Squat2–3 × 10–15 (sets/reps: our default)

Wall Squat (Wall Sit)2–3 × 10–15 (sets/reps: our default)

Standing Terminal Knee Extension with Resistance2–3 × 10–15 (sets/reps: our default)

Bridge (Bilateral)2–3 × 10–15 (sets/reps: our default)

Hip Abduction (Side-Lying)2–3 × 10–15 (sets/reps: our default)

Single Leg Balance3 × 30 s (sets/reps: our default)

Stationary Bikefor motion, as tolerated (sets/reps: our default)

Seated Knee Flexion Stretchshort bouts through the day, toward 120° (sets/reps: our default)

Advance to Phase 3 when

Full extension and at least 120° flexion^[5] (yes/no check) test: Knee ROM
Normal gait without crutches^{[5, 7]} (yes/no check)
Effusion trace or less on the modified stroke test^[7] (yes/no check) test: Stroke test

Phase 3 · Strength

wk 6–12Create HEP for Phase 3 →

Allowed

Progressive strength: lighter loads and many repetitions first, then heavier loads^{[6, 15]}
Eccentric with concentric work; open and closed chain together^[1]
Single-leg balance and control^{[7, 1]}

Avoid

Open-chain knee extension past 45° (none before wk 4) (until wk 12)
Pivoting and cutting sport until the return-to-sport criteria are met (not before 9 months)^{[18, 6]}

Exercises

Leg Press3 × 12–20 RM

Step Up3 × 12–20 RM

Lateral Step Down3 × 12–20 RM

Forward Lunge3 × 12–20 RM

Split Squat3 × 12–20 RM

Single Leg Bridge3 × 12–20 RM

Banded Side Step2 × 10 steps each way (sets/reps: our default)

Single Leg Balance with Ball Toss3 × 30 s (sets/reps: our default)

Advance to Phase 4 when

At least 12 weeks since surgery^[1]
Quadriceps strength ≥ 80% of the other leg^{[1, 7]} test: Quad strength
Effusion trace or less on the modified stroke test^{[7, 1]} (yes/no check) test: Stroke test
Full knee ROM, equal to the other knee^{[1, 7]} (yes/no check) test: Knee ROM

Phase 4 · Running and landing

wk 12–24Create HEP for Phase 4 →

Allowed

Running: no more than 4 times a week, every other day at most; move up a level when a run causes no extra effusion or pain^[7]
Plyometrics in 4 stages, building from 50 to 200 foot contacts a session^[17]
Heavier single-leg strength^[15]

Avoid

Pivoting and cutting sport until the return-to-sport criteria are met (not before 9 months)^{[18, 6]}

Exercises

Single Leg Romanian Deadlift3 × 5–15 RM

Single Leg Heel Raise3 × 5–15 RM

Side Plank3 × 30 s (sets/reps: our default)

Split Squat3 × 5–15 RM

Lateral Step Down3 × 5–15 RM

Advance to Phase 5 when

Quadriceps strength ≥ 90% of the other leg^{[7, 18]} test: Quad strength
All four hop tests ≥ 90% of the other leg (single, triple, crossover and 6 m timed hop)^{[7, 18]} tests: Single hop, Triple hop, Crossover hop, 6 m timed hop

Phase 5 · Return to sport

wk 24–52Create HEP for Phase 5 →

Allowed

Cutting drills, shallow cuts before sharp ones^[17]
Full team training for at least 4–6 weeks before competition^[5]

Avoid

Pivoting and cutting sport until the return-to-sport criteria are met (not before 9 months)^{[18, 6]}

Exercises

Single Leg Romanian Deadlift60–80% 1RM or 1–5 RM

Single Leg Heel Raise60–80% 1RM or 1–5 RM

Single Leg Balance with Ball Toss3 × 30 s (sets/reps: our default)

Discharge from PT when

At least 9 months since surgery^{[18, 6]}
Quadriceps strength ≥ 90% of the other leg^{[7, 18]} test: Quad strength
All four hop tests ≥ 90% of the other leg (single, triple, crossover and 6 m timed hop)^{[7, 18]} tests: Single hop, Triple hop, Crossover hop, 6 m timed hop
ACL-RSI ≥ 65^[21] test: ACL-RSI
At least 4–6 weeks of full team training before competition^[5] (yes/no check)
Shared clearance with the surgeon and the team^[3]

Return to pivoting sport when

At least 9 months since surgery^{[18, 6]}
Quadriceps strength ≥ 90% of the other leg^{[7, 18]} test: Quad strength
All four hop tests ≥ 90% of the other leg (single, triple, crossover and 6 m timed hop)^{[7, 18]} tests: Single hop, Triple hop, Crossover hop, 6 m timed hop
ACL-RSI ≥ 65^[21] test: ACL-RSI
At least 4–6 weeks of full team training before competition^[5] (yes/no check)
Shared clearance with the surgeon and the team^[3]

Phase	Allowed	Avoid	Exercises	Advance / discharge when
Phase 1 · Protect and extend wk 0–2	Knee motion and weight bearing from the first week^[1] Quad sets with NMES, started in week 1^{[12, 1]} Self patellar mobilization in the home program^[7] Patellar tendon graft: patellar mobilization emphasized, and watch for patellar tendon pain during quadriceps loading^{[15, 7]} Heel props or prone hangs if extension is not full^{[5, 7]}	Open-chain knee extension past 45° (none before wk 4) (until wk 12) Driving, until emergency braking is safe (until wk 6) Pool work until the wound has fully healed (about wk 3–4)^[1]	Quad Set 2–3 × 10–15 (sets/reps: our default) Active Straight Leg Raise with Quad Set 2–3 × 10–15 (sets/reps: our default) Ankle Pumps 2–3 × 10–15 (sets/reps: our default) Seated Knee Extension Stretch (Heel Prop) 10 min with no weight, then add weight and time Prone Knee Extension Overpressure (Prone Hang) 10 min with no weight, then add ankle weight and time Supine Heel Slide 2–3 × 10–15 (sets/reps: our default) Wall Slide (Hook-Lying) 2–3 × 10–15 (sets/reps: our default) Standing Calf Raise 2–3 × 10–15 (sets/reps: our default)	Full passive knee extension, equal to the other knee^{[7, 6]} (yes/no check) test: Knee ROM Straight leg raise without extension lag^{[7, 6]} (yes/no check) test: SLR, no lag Effusion 1+ or less on the modified stroke test^[7] (yes/no check) test: Stroke test
Phase 2 · Motion and gait wk 2–6	Open-chain knee extension in 90–45° from wk 4^[1] Stationary bike for motion^{[7, 5]} Open and closed chain strength together, and balance^[1] Blood flow restriction training, optional^{[1, 13]}	Open-chain knee extension past 45° (none before wk 4) (until wk 12) Driving, until emergency braking is safe (until wk 6) Pool work until the wound has fully healed (about wk 3–4)^[1]	Seated Long Arc Quad 90–45° only, 3 × 12–20 RM · from wk 4 Standing Mini Squat 2–3 × 10–15 (sets/reps: our default) Wall Squat (Wall Sit) 2–3 × 10–15 (sets/reps: our default) Standing Terminal Knee Extension with Resistance 2–3 × 10–15 (sets/reps: our default) Bridge (Bilateral) 2–3 × 10–15 (sets/reps: our default) Hip Abduction (Side-Lying) 2–3 × 10–15 (sets/reps: our default) Single Leg Balance 3 × 30 s (sets/reps: our default) Stationary Bike for motion, as tolerated (sets/reps: our default) Seated Knee Flexion Stretch short bouts through the day, toward 120° (sets/reps: our default)	Full extension and at least 120° flexion^[5] (yes/no check) test: Knee ROM Normal gait without crutches^{[5, 7]} (yes/no check) Effusion trace or less on the modified stroke test^[7] (yes/no check) test: Stroke test
Phase 3 · Strength wk 6–12	Progressive strength: lighter loads and many repetitions first, then heavier loads^{[6, 15]} Eccentric with concentric work; open and closed chain together^[1] Single-leg balance and control^{[7, 1]}	Open-chain knee extension past 45° (none before wk 4) (until wk 12) Pivoting and cutting sport until the return-to-sport criteria are met (not before 9 months)^{[18, 6]}	Leg Press 3 × 12–20 RM Step Up 3 × 12–20 RM Lateral Step Down 3 × 12–20 RM Forward Lunge 3 × 12–20 RM Split Squat 3 × 12–20 RM Single Leg Bridge 3 × 12–20 RM Banded Side Step 2 × 10 steps each way (sets/reps: our default) Single Leg Balance with Ball Toss 3 × 30 s (sets/reps: our default)	At least 12 weeks since surgery^[1] Quadriceps strength ≥ 80% of the other leg^{[1, 7]} test: Quad strength Effusion trace or less on the modified stroke test^{[7, 1]} (yes/no check) test: Stroke test Full knee ROM, equal to the other knee^{[1, 7]} (yes/no check) test: Knee ROM
Phase 4 · Running and landing wk 12–24	Running: no more than 4 times a week, every other day at most; move up a level when a run causes no extra effusion or pain^[7] Plyometrics in 4 stages, building from 50 to 200 foot contacts a session^[17] Heavier single-leg strength^[15]	Pivoting and cutting sport until the return-to-sport criteria are met (not before 9 months)^{[18, 6]}	Single Leg Romanian Deadlift 3 × 5–15 RM Single Leg Heel Raise 3 × 5–15 RM Side Plank 3 × 30 s (sets/reps: our default) Split Squat 3 × 5–15 RM Lateral Step Down 3 × 5–15 RM	Quadriceps strength ≥ 90% of the other leg^{[7, 18]} test: Quad strength All four hop tests ≥ 90% of the other leg (single, triple, crossover and 6 m timed hop)^{[7, 18]} tests: Single hop, Triple hop, Crossover hop, 6 m timed hop
Phase 5 · Return to sport wk 24–52	Cutting drills, shallow cuts before sharp ones^[17] Full team training for at least 4–6 weeks before competition^[5]	Pivoting and cutting sport until the return-to-sport criteria are met (not before 9 months)^{[18, 6]}	Single Leg Romanian Deadlift 60–80% 1RM or 1–5 RM Single Leg Heel Raise 60–80% 1RM or 1–5 RM Single Leg Balance with Ball Toss 3 × 30 s (sets/reps: our default)	Discharge from PT: At least 9 months since surgery^{[18, 6]} Quadriceps strength ≥ 90% of the other leg^{[7, 18]} test: Quad strength All four hop tests ≥ 90% of the other leg (single, triple, crossover and 6 m timed hop)^{[7, 18]} tests: Single hop, Triple hop, Crossover hop, 6 m timed hop ACL-RSI ≥ 65^[21] test: ACL-RSI At least 4–6 weeks of full team training before competition^[5] (yes/no check) Shared clearance with the surgeon and the team^[3] Return to pivoting sport: At least 9 months since surgery^{[18, 6]} Quadriceps strength ≥ 90% of the other leg^{[7, 18]} test: Quad strength All four hop tests ≥ 90% of the other leg (single, triple, crossover and 6 m timed hop)^{[7, 18]} tests: Single hop, Triple hop, Crossover hop, 6 m timed hop ACL-RSI ≥ 65^[21] test: ACL-RSI At least 4–6 weeks of full team training before competition^[5] (yes/no check) Shared clearance with the surgeon and the team^[3]

How published protocols differ

Published protocols agree on early motion and weight bearing and on criteria-based progress, and differ most on the brace, when open-chain knee extension starts, when running starts and the return-to-sport cut-offs.

Decision points across published ACL reconstruction protocols (facts in our words, each linked to its source).
Decision point	This protocol	Sanford Health^[26]source ↗ · rev. Apr 2026 · checked Oct 2026	Mass General Brigham^[27]source ↗ · rev. Aug 2024 · checked Oct 2026	Gundersen Health System^[28]source ↗ · updated Nov 2019 · checked Oct 2026
Post-op brace	Only if the surgeon prescribes one; unlocked once a straight leg raise has no lag; off when the surgeon discontinues it (typically wk 4–6)	Drop-lock brace for 6 wk, locked straight for walking; unlocked once a straight leg raise has no lag	Locked at first; unlocked once a straight leg raise has no lag; off after 6 wk per the surgeon	Not every patient; locked for walking and sleep in wk 0–1, then unlocked with good quad control; off at wk 4
Weight bearing	WBAT with crutches from day 0, unless the surgeon restricts it	From day 0 with the brace locked straight; crutches as needed for 7–14 days	WBAT with the brace locked; partial weight bearing for 6 wk after a hamstring graft or allograft	WBAT from day 0; crutches off once heel-to-toe gait is normal
Open-chain knee extension	90–45° from wk 4; full range from wk 12	90–45° from early post-op, opening 10° a week; 90–0° at wk 12	Isometrics at 90° and 60° in wk 0–2; 90–45° with resistance from wk 6–8; no later range given	No resisted open chain before wk 6; then 90–30°; full range at 4 mo
Running	From wk 12, once quadriceps strength is ≥ 80%, effusion trace or less and ROM full	4 mo, after Level 1 testing and a ready-to-run test	Months 3–5, after over 80% on its functional assessment	3–4 mo (its benchmarks say at least 4 mo), with quad and hamstring strength at 75%
Return to sport	From 9 mo; quadriceps and all four hops ≥ 90%; ACL-RSI ≥ 65	After Level 2 testing at 7+ mo; symmetry ≥ 90%; ACL-RSI over 90%	Full play at about 9–12 mo; strength and hops ≥ 95%; ACL-RSI 90% or more	9–12 mo; isokinetic strength and hops 90%; ACL-RSI collected, no cut-off
Meniscus repair covered?	Yes (add-on)	Not in the ACL guideline	Yes, the more conservative plan; no numbers	Yes, its meniscus program for wk 0–8

Different numbers from the surgeon?

Match the surgeon's protocol →

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Each value is a fact in our words, linked to its source with the version and the date we checked it. Not affiliated with or endorsed by the institutions listed.

Tests and measures

Strength and hop results are limb symmetry: the operated leg as a share of the other. Symmetry can flatter the knee, since the other leg also weakens; comparing with the leg's capacity before surgery is stricter^[22].

Tests and measures, Patellar tendon autograft
Test	Phase 1 exit	Phase 2 exit	Phase 3 exit · return to running	Phase 4 exit	Discharge · return to pivoting sport
Modified stroke test	effusion 1+ or less	effusion trace or less	effusion trace or less
Knee effusion, graded zero, trace, 1+, 2+ or 3+. Stroke test on the knee; trace or less is the usual gate for running and hop testing^[7]
Knee range of motion	full passive extension	full extension, flexion ≥120°	full knee ROM
Knee extension and flexion, compared with the other knee. Measured against the other knee; full extension means matching it^{[5, 7]}
Straight leg raise without extension lag	SLR without lag
Quadriceps control at full extension. The knee stays fully straight through a straight leg raise^{[5, 7]}
Quadriceps strength on a dynamometer			≥ 80%	≥ 90%	≥ 90%
Quadriceps strength of the operated leg as a share of the other leg (limb symmetry index). Isokinetic at 60°/s, or isometric at 60° of knee flexion; operated ÷ other leg × 100. Manual muscle testing is not a valid strength measure^{[1, 7, 18]}
Single hop for distance				≥ 90%	≥ 90%
Single-leg hop distance, as limb symmetry. Hop battery: 2 practice and 2 measured trials per leg^{[7, 18]}
Triple hop for distance				≥ 90%	≥ 90%
Three consecutive single-leg hops, distance as limb symmetry. Hop battery: 2 practice and 2 measured trials per leg^{[7, 18]}
Crossover hop for distance				≥ 90%	≥ 90%
Three single-leg hops crossing a line, distance as limb symmetry. Hop battery: 2 practice and 2 measured trials per leg^{[7, 18]}
6 m timed hop				≥ 90%	≥ 90%
Single-leg hop speed over 6 m, as limb symmetry. Hop battery: 2 practice and 2 measured trials per leg^{[7, 18]}
Lateral step-down (movement quality)	Tracked, not a gate
Movement quality in a single-leg step-down. Watched or filmed; no published pass mark, so tracked, not a gate^[5]
Y balance test	Tracked, not a gate
Single-leg dynamic balance (reach distance), compared with the other side. No published pass mark, so tracked, not a gate; reach deficits often remain at return to sport^[3]
IKDC Subjective Knee Form	Tracked, not a gate
Self-reported knee symptoms, function and sport activity. Scored 0 to 100; acceptable symptom state 75.9, minimal important change 11.5^{[4, 24]} Copyrighted instrument: named and linked, never reproduced. About the instrument ↗
ACL Return to Sport after Injury scale (ACL-RSI)					≥ 65 points
Psychological readiness to return to sport. Self-reported; scores rise early after surgery and then change little for years^{[21, 23]} Copyrighted instrument: named and linked, never reproduced. About the instrument ↗

Each pass mark is this protocol's clinical call, cited to its sources. Questionnaires are named and linked, never reproduced.

References and basis

Reviewed by a licensed physical therapist (HEP Drop staff)Page reviewed Oct 2026Literature checked through Oct 2026Protocols checked Oct 2026Version 2026.10 · changelogHow we write protocols

What backs each recommendation

Our summary, in our own words, of what each source supports. "Strongest evidence" is the study design as published; a review that pools only cadaver studies is listed as a lab study. "Limited evidence" means no randomized trial or systematic review of patient studies is among that row's sources; we do not grade our own recommendations.

What backs each recommendation, Patellar tendon autograft
Recommendation	This protocol	Based on	Strongest evidence	What's uncertain
Phase 1 · Protect and extend · wk 0–2
Weight bearing	as tolerated with crutches from day 0, unless the surgeon restricts it; no crutches typically wk 1–2	[1] Kotsifaki 2023 [15] Briem 2026	Guideline Limited evidence	One meta-analysis tied full weight bearing within 2 weeks to more laxity, with better IKDC scores^[8].
Brace	only if the surgeon prescribes one; unlocked once a straight leg raise has no lag (typically wk 1–2); off when the surgeon discontinues it (typically wk 4–6)	[9] Lin 2025 [2] Brophy 2023 [7] Adams 2012	Systematic review	The evidence recommends no routine brace^{[9, 2]}, and no source gives a locked angle; the compared protocols all use one, and the typical weeks (unlock wk 1–2, off wk 4–6) come from them, not from the literature (see How protocols differ).
Full extension	by wk 2	[7] Adams 2012 [5] van Melick 2023	Consensus Limited evidence
Phase 1 criteria	full passive extension, a straight leg raise without lag, effusion 1+ or less	[7] Adams 2012 [6] Filbay 2019	Narrative review Limited evidence	The literature's first-phase exits ask for trace or no effusion^{[5, 6]}; 1+ or less is our clinical call.
Phase 2 · Motion and gait · wk 2–6
Open-chain knee extension	90–45° from wk 4; full range from wk 12	[1] Kotsifaki 2023 [15] Briem 2026	Guideline Limited evidence	Very low certainty with strong expert agreement for 90–45° from wk 4^[1]; no source gives a week for full range after a patellar tendon or hamstring graft or an allograft, so wk 12 is our default.
Phase 3 · Strength · wk 6–12
Running	from wk 12: quadriceps ≥ 80%, effusion trace or less, full ROM	[1] Kotsifaki 2023 [7] Adams 2012	Guideline Limited evidence	The running criteria are expert opinion^[1]; other sources start at 8 weeks^[7] or at 70% strength^{[17, 5]}.
Phase 5 · Return to sport · wk 24–52
Pivoting sport	from 9 mo: quadriceps and all four hops ≥ 90%, ACL-RSI ≥ 65, 4–6 weeks of full training	[18] Grindem 2016 [6] Filbay 2019 [7] Adams 2012 [21] Webster 2020 [5] van Melick 2023	Cohort study Limited evidence	Whether passing a test battery lowers reinjury is not clear^{[1, 20]}, and symmetry can flatter the knee, since the other leg also weakens^[22].
Modifiers
Hamstring graft	no resisted knee flexion to wk 8; hamstring isometrics from wk 4Graft toggle	[15] Briem 2026 [7] Adams 2012	Scoping review Limited evidence	6–8 weeks across guidelines^[15], 12 weeks in one program^[7]; no consensus^[6].
Quad tendon graft	the same weeks as the default; mobility first, and the tendon limits plyometricsGraft toggle	[14] Solie 2023 [15] Briem 2026	Scoping review Limited evidence	Quadriceps tendon grafts are thin in the evidence: one commentary and one guideline in a review^{[14, 15]}.
Allograft	the same weeks as the default; do not advance faster because pain is lowerGraft toggle	[7] Adams 2012 [19] Wiggins 2016 [2] Brophy 2023	Systematic review
Meniscus repair add-on	no weight-bearing flexion past 45° to wk 4, past 90° to wk 8; full weight bearing in extensionMeniscus toggle	[7] Adams 2012 [16] Spang 2018	Systematic review	No consensus on rehab after meniscal repair, from low-quality studies; accelerated protocols were not linked to more failures^[16].

Where evidence is limited

Weight bearing: One meta-analysis tied full weight bearing within 2 weeks to more laxity, with better IKDC scores^[8].
Phase 1 criteria: The literature's first-phase exits ask for trace or no effusion^{[5, 6]}; 1+ or less is our clinical call.
Open-chain knee extension: Very low certainty with strong expert agreement for 90–45° from wk 4^[1]; no source gives a week for full range after a patellar tendon or hamstring graft or an allograft, so wk 12 is our default.
Running: The running criteria are expert opinion^[1]; other sources start at 8 weeks^[7] or at 70% strength^{[17, 5]}.
Pivoting sport: Whether passing a test battery lowers reinjury is not clear^{[1, 20]}, and symmetry can flatter the knee, since the other leg also weakens^[22].
Hamstring graft: 6–8 weeks across guidelines^[15], 12 weeks in one program^[7]; no consensus^[6].
Quad tendon graft: Quadriceps tendon grafts are thin in the evidence: one commentary and one guideline in a review^{[14, 15]}.

Bibliography

1.Kotsifaki R, Korakakis V, King E, et al. Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. Br J Sports Med. 2023;57(9):500–514.
Guideline (Aspetar CPG, GRADE, 140 RCTs, recommendations with expert agreement) · PMC11785408 (free full text) · doi:10.1136/bjsports-2022-106158 · CC BY-NC 4.0 · cited, not reproduced · Used for: Weight bearing · Open-chain knee extension · Running
2.Brophy RH, Lowry KJ. American Academy of Orthopaedic Surgeons Clinical Practice Guideline Summary: Management of Anterior Cruciate Ligament Injuries. J Am Acad Orthop Surg. 2023;31(11):531–537.
Guideline (AAOS CPG 2022, summary of 8 recommendations and 7 options) · PMC10168113 (free full text) · doi:10.5435/jaaos-d-22-01020 · CC BY-NC-ND 4.0 · cited, not reproduced · Used for: Brace · Allograft
3.Meredith SJ, Rauer T, Chmielewski TL, et al. Return to Sport After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Return to Sport Consensus Group. Orthop J Sports Med. 2020;8(6):2325967120930829.
Consensus statement (Panther Symposium 2019, return to sport (11 statements)) · PMC7328222 (free full text) · doi:10.1177/2325967120930829 · CC BY-NC-ND 4.0 · cited, not reproduced
4.Svantesson E, Hamrin Senorski E, Webster KE, et al. Clinical outcomes after anterior cruciate ligament injury: panther symposium ACL injury clinical outcomes consensus group. Knee Surg Sports Traumatol Arthrosc. 2020;28(8):2415–2434.
Consensus statement (Panther Symposium 2019, clinical outcome measures (9 statements)) · PMC7429530 (free full text) · doi:10.1007/s00167-020-06061-x · CC BY 4.0 · cited
5.van Melick N, Dietvorst M, van Oort MIAM, et al. Anterior Cruciate Ligament Rehabilitation for the 10- to 18-Year-Old Adolescent Athlete: Practice Guidelines Based on International Delphi Consensus. Orthop J Sports Med. 2023;11(7):23259671231172454.
Consensus statement (international Delphi, rehab for athletes aged 10 to 18) · PMC10363891 (free full text) · doi:10.1177/23259671231172454 · CC BY-NC-ND 4.0 · cited, not reproduced · Used for: Full extension · Pivoting sport
6.Filbay SR, Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol. 2019;33(1):33–47.
Narrative review (evidence-based management, 5 phases with goals and return-to-sport criteria) · PMC6723618 (free full text) · doi:10.1016/j.berh.2019.01.018 · CC BY 4.0 · cited · Used for: Phase 1 criteria · Pivoting sport
7.Adams D, Logerstedt DS, Hunter-Giordano A, et al. Current concepts for anterior cruciate ligament reconstruction: a criterion-based rehabilitation progression. J Orthop Sports Phys Ther. 2012;42(7):601–614.
Narrative review (Delaware criterion-based progression with milestones (clinical commentary)) · PMC3576892 (free full text) · doi:10.2519/jospt.2012.3871 · © publisher · cited only · Used for: Brace · Full extension · Phase 1 criteria · Running · Pivoting sport · Hamstring graft · Allograft · Meniscus repair add-on
8.Fan Z, Yan J, Zhou Z, et al. Delayed versus Accelerated Weight-bearing Rehabilitation Protocol Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. J Rehabil Med. 2022;54:jrm00260.
Systematic review (accelerated vs delayed weight bearing, 9 studies) · PMC8892302 (free full text) · doi:10.2340/jrm.v53.1438 · CC BY-NC 4.0 · cited, not reproduced
9.Lin Q, Li Z, Li M, et al. Effects of postoperative knee bracing on knee function and stability after anterior cruciate ligament reconstruction: A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2025;33(12):4398–4411.
Systematic review (post-op brace vs none, 11 studies, n = 785) · PMC12684331 (free full text) · doi:10.1002/ksa.70098 · CC BY 4.0 · cited · Used for: Brace
10.D'Amore T, Rao S, Corvi J, et al. The Utility of Continuous Passive Motion After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Comparative Studies. Orthop J Sports Med. 2021;9(6):23259671211013841.
Systematic review (CPM vs none, 12 studies, n = 808) · PMC8246506 (free full text) · doi:10.1177/23259671211013841 · CC BY-NC-ND 4.0 · cited, not reproduced
11.Yang JH, Hwang KT, Lee MK, et al. Comparison of a Cryopneumatic Compression Device and Ice Packs for Cryotherapy Following Anterior Cruciate Ligament Reconstruction. Clin Orthop Surg. 2023;15(2):234–240.
RCT (cold-compression device vs ice packs, n = 56) · PMC10060780 (free full text) · doi:10.4055/cios21246 · CC BY-NC 4.0 · cited, not reproduced
12.Li Z, Jin L, Chen Z, et al. Effects of Neuromuscular Electrical Stimulation on Quadriceps Femoris Muscle Strength and Knee Joint Function in Patients After ACL Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Orthop J Sports Med. 2025;13(1):23259671241275071.
Systematic review (NMES added to rehab, 11 RCTs, n = 202) · PMC11729445 (free full text) · doi:10.1177/23259671241275071 · CC BY-NC-ND 4.0 · cited, not reproduced
13.Colombo V, Valenčič T, Steiner K, et al. Comparison of Blood Flow Restriction Interventions to Standard Rehabilitation After an Anterior Cruciate Ligament Injury: A Systematic Review. Am J Sports Med. 2024;52(14):3641–3650.
Systematic review (blood flow restriction vs standard rehab, 5 studies) · PMC11608515 (free full text) · doi:10.1177/03635465241232002 · CC BY-NC 4.0 · cited, not reproduced
14.Solie B, Monson J, Larson C. Graft-Specific Surgical and Rehabilitation Considerations for Anterior Cruciate Ligament Reconstruction with the Quadriceps Tendon Autograft. Int J Sports Phys Ther. 2023;18(2):493–512.
Narrative review (quadriceps tendon graft surgery and rehab (clinical commentary, level 5)) · PMC10069402 (free full text) · doi:10.26603/001c.73797 · CC BY-NC 4.0 · cited, not reproduced · Used for: Quad tendon graft
15.Briem K, Zebis MK, Haraldsson BÞ, et al. Rehabilitation guidelines after autograft anterior cruciate ligament reconstruction need more graft-specific exercise recommendations-A scoping review. Knee Surg Sports Traumatol Arthrosc. 2026;34(1):83–101.
Scoping review (exercise recommendations by graft in 17 guidelines) · PMC12747633 (free full text) · doi:10.1002/ksa.12666 · CC BY 4.0 · cited · Used for: Weight bearing · Open-chain knee extension · Hamstring graft · Quad tendon graft
16.Spang Iii RC, Nasr MC, Mohamadi A, et al. Rehabilitation following meniscal repair: a systematic review. BMJ Open Sport Exerc Med. 2018;4(1):e000212.
Systematic review (rehab after meniscal repair, 17 clinical studies) · PMC5905745 (free full text) · doi:10.1136/bmjsem-2016-000212 · CC BY-NC 4.0 · cited, not reproduced · Used for: Meniscus repair add-on
17.Buckthorpe M, Della Villa F. Recommendations for Plyometric Training after ACL Reconstruction - A. Clinical Commentary. Int J Sports Phys Ther. 2021;16(3):879–895.
Narrative review (4-stage plyometric program with entry criteria (clinical commentary)) · PMC8169025 (free full text) · doi:10.26603/001c.23549 · CC BY-NC 4.0 · cited, not reproduced
18.Grindem H, Snyder-Mackler L, Moksnes H, et al. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804–808.
Cohort study (n = 106, Delaware-Oslo, return-to-sport timing, criteria and reinjury) · PMC4912389 (free full text) · doi:10.1136/bjsports-2016-096031 · © publisher · cited only · Used for: Pivoting sport
19.Wiggins AJ, Grandhi RK, Schneider DK, et al. Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med. 2016;44(7):1861–1876.
Systematic review (second ACL injury rates, 19 studies) · PMC5501245 (free full text) · doi:10.1177/0363546515621554 · © publisher · cited only · Used for: Allograft
20.Zhou W, Liu X, Hong Q, et al. Association between passing return-to-sport testing and re-injury risk in patients after anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis. PeerJ. 2024;12:e17279.
Systematic review (passing return-to-sport tests and reinjury, 9 studies, n = 1410) · PMC11064852 (free full text) · doi:10.7717/peerj.17279 · CC BY 4.0 · cited
21.Webster KE, Feller JA. Who Passes Return-to-Sport Tests, and Which Tests Are Most Strongly Associated With Return to Play After Anterior Cruciate Ligament Reconstruction? Orthop J Sports Med. 2020;8(12):2325967120969425.
Cohort study (n = 450, which 6-month tests go with return to sport at 12 months) · PMC7750778 (free full text) · doi:10.1177/2325967120969425 · CC BY-NC-ND 4.0 · cited, not reproduced · Used for: Pivoting sport
22.Wellsandt E, Failla MJ, Snyder-Mackler L. Limb Symmetry Indexes Can Overestimate Knee Function After Anterior Cruciate Ligament Injury. J Orthop Sports Phys Ther. 2017;47(5):334–338.
Cohort study (n = 70, limb symmetry vs estimated pre-injury capacity) · PMC5483854 (free full text) · doi:10.2519/jospt.2017.7285 · © publisher · cited only
23.Sell TC, Zerega R, King V, et al. Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL-RSI) Scores over Time After Anterior Cruciate Ligament Reconstruction: A Systematic Review with Meta-analysis. Sports Med Open. 2024;10(1):49.
Systematic review (ACL-RSI scores over time, 83 studies) · PMC11061071 (free full text) · doi:10.1186/s40798-024-00712-w · CC BY 4.0 · cited
24.Collins NJ, Misra D, Felson DT, et al. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S208–28.
Narrative review (measurement properties of IKDC, KOOS, Lysholm, Tegner and others) · PMC4336550 (free full text) · doi:10.1002/acr.20632 · © publisher · cited only
25.Salem HS, Park DH, Friedman JL, et al. Return to Driving After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Orthop J Sports Med. 2021;9(1):2325967120968556.
Systematic review (return to driving, 5 studies) · PMC7829529 (free full text) · doi:10.1177/2325967120968556 · CC BY-NC-ND 4.0 · cited, not reproduced

Published protocols compared (26–29)

Compared, not endorsed. Not affiliated with or endorsed by the institutions listed. Versions and checked dates match the How published protocols differ table.

26.Sanford Health. ACL reconstruction rehabilitation guideline [PDF]. Revised Apr 2026.
Published protocol · Protocol PDF (www.sanfordhealth.org/-/media/org/files/medical-professionals/resources-and-education/acl-reconstruction-guideline.pdf) · checked Oct 2026 · Compared, not endorsed · Used for: How protocols differ · Key milestones: published ranges
27.Mass General Brigham. Rehabilitation protocol for ACL reconstruction [PDF]. Revised Aug 2024.
Published protocol · Protocol PDF (www.massgeneralbrigham.org/content/dam/unified-xwalk/pdf/patient-education/english/rehabilitation-protocol-for-acl.pdf) · checked Oct 2026 · Compared, not endorsed · Used for: How protocols differ · Key milestones: published ranges
28.Gundersen Health System. ACL reconstruction rehabilitation program [PDF]. Version updated Nov 2019.
Published protocol · Protocol PDF (www.gundersenhealth.org/sites/default/files/2022-06/Sports-Medicine-Protocol-ACL-Reconstruction.pdf) · checked Oct 2026 · Compared, not endorsed · Used for: How protocols differ · Key milestones: published ranges
29.UW Health. ACL reconstruction in the adult athlete with quadriceps tendon graft [PDF]. Version © 2025.
Published protocol · Guideline PDF (bynder.uwhealth.org/m/7b41045306bae87f/original/ACL-Reconstruction-in-the-Adult-Athlete-with-QT-graft.pdf) · checked Oct 2026 · Compared, not endorsed

Licenses and adaptation. All are licensed under CC BY 4.0 (creativecommons.org/licenses/by/4.0). No warranties are given by the original authors.

[2] Brophy 2023, [3] Meredith 2020, [5] van Melick 2023, [10] D'Amore 2021, [12] Li 2025, [21] Webster 2020 and [25] Salem 2021 are CC BY-NC-ND 4.0 and [1] Kotsifaki 2023, [8] Fan 2022, [11] Yang 2023, [13] Colombo 2024, [14] Solie 2023, [16] Spang 2018 and [17] Buckthorpe 2021 are CC BY-NC 4.0: we summarize their findings in our own words and reproduce no text, tables or figures. [7] Adams 2012, [18] Grindem 2016, [19] Wiggins 2016, [22] Wellsandt 2017, [24] Collins 2011 and [29] UW Health are not openly licensed (all rights reserved): we state their findings and numbers in our own words and reproduce no text, tables or figures.

Published protocols [26]–[29] are compared, not endorsed. Not affiliated with or endorsed by the institutions listed.

Changelog

Version	Date	What changed	Type	Recommendations affected	Reviewed by	Sources
2026.10	Oct 2026	First published version	—	All	Licensed PT	29

Cite this protocolHEP Drop. ACL reconstruction rehabilitation protocol. Version 2026.10. Reviewed Oct 2026. hepdrop.com/p/acl

For specific clinical claims, cite the original sources above.

ACL Reconstruction Protocol · Patellar tendon autograft · Version 2026.10 · hepdrop.com/p/acl · The operating surgeon's protocol takes precedence.

Milestone	This protocol	Range in published protocols
Brace off	wk 4	wk 4–6^{[26, 27, 28]}, two of three at about wk 6
Open chain 90–45°	wk 4	early post-op to wk 8^{[26, 27, 28]}, two of three at wk 6
Open chain, full range	wk 12	wk 12 to 4 mo^{[26, 28]}, two give a week: wk 12 and 4 mo
Running	wk 12	3 to 5 mo^{[26, 27, 28]}, all three include 4 mo
Pivoting sport	from 9 mo	9–12 mo^{[27, 28]}, two of three at 9–12 mo; one gives no month

ACL Reconstruction Protocol

Timeline

Phase

Weight bearing

Brace (if prescribed)

Motion

Strength

Care

Restrictions

Milestones

Phase 1 · Protect and extend

Key milestones by week

All phases

Phase 1 · Protect and extend

Phase 2 · Motion and gait

Phase 3 · Strength

Phase 4 · Running and landing

Phase 5 · Return to sport

How published protocols differ

Tests and measures

References and basis

What backs each recommendation

Bibliography

Published protocols compared (26–29)

Changelog

ACL Reconstruction Protocol

ACL Reconstruction Protocol · exercises and sources

Exercises by phase * sets and reps are our default.

Phase 1 · Protect and extend wk 0–2

Phase 2 · Motion and gait wk 2–6

Phase 3 · Strength wk 6–12

Phase 4 · Running and landing wk 12–24

Phase 5 · Return to sport wk 24–52

Return to pivoting sport when

Tests and pass marks

Key milestones vs published protocols

Sources

Test	Phase 1 exit	Phase 2 exit	Phase 3 exit · return to running	Phase 4 exit	Discharge · return to pivoting sport
Stroke test^[7]	effusion 1+ or less	effusion trace or less	effusion trace or less
Knee ROM^{[5, 7]}	full passive extension	full extension, flexion ≥120°	full knee ROM
SLR, no lag^{[5, 7]}	SLR without lag
Quad strength^{[1, 7, 18]}			≥ 80%	≥ 90%	≥ 90%
Single hop, Triple hop, Crossover hop, 6 m timed hop^{[7, 18]}				≥ 90%	≥ 90%
ACL-RSI^{[21, 23]}					≥ 65 points