The MOON Knee Anterior Cruciate Ligament Rehabilitation Program

Photo: Cleveland Clinic Sports Medicine

How do I get back to normal life activity after anterior cruciate ligament reconstruction surgery? To my sport?

The best way is to follow and complete an evidence-based post-surgery ACL rehabilitation program under the guidance of a physical therapist or athletic trainer.

Designed by a team of physicians and physical therapists with proven ACL rehabilitation experience, the widely used MOON Knee Group program is based on one of the most published long-term ACL research projects.

The program has five phases. Each has specific goals, exercises and instructions.

The MOON Knee Group ACL Rehabilitation Program:

  • Follows a phased approach that assures completion of one phase before moving to the next.
  • Uses testing throughout the program to create confidence in guidance for your return to normal activity and sport.
  • Advances at a pace appropriate for you, not according to a timeline.

How Much Functionality Can I Regain?

Most patients following this program can achieve 90 percent or better of their original functionality. If followed by a return-to-sport program, you can also reduce your risk of a retear by 40 to 60 percent.

Success depends on completing each phase before moving on to the next. Your physician, physical therapist or athletic trainer will measure your progress and instruct you on when to advance.

Evidence-Based ACL Rehabilitation

MOON Knee Group research is funded by grants from the National Institutes of Health, which is part of the US Department of Health and Human Services. This rehabilitation program and all MOON Knee Group findings are freely distributed.


The Importance of Trained Medical Guidance

Your ACL rehabilitation should be done under the guidance of a trained physician, physical therapist or athletic trainer familiar with the MOON Knee or similar rehabilitation programs. (Medical professionals can download the MOON Knee rehabilitation program outline here.)

Your medical team can assess your progress, identify issues, ensure you do the exercises properly and determine when to advance to the next phase. Your chances of rehabilitation success are reduced without this testing and guidance.

Your body and injury are unique. Just following written instruction is not enough. Success comes through a phased approach to post-surgery rehabilitation with testing and observation by a trained professional.

When Can I Return to Activities and Sport?

Progress through the phases of the MOON Knee rehabilitation program is based on functionality, not time. Being able to completely straighten your leg is required before moving from Phase 1 to Phase 2, for example.

Completing each phase before moving to the next ensures your knee is ready for the challenges at each step.

Note that there is a difference in functionality—being able to do something—and being able to do it with strength. Strength takes longer to regain.

Below are basic guidelines for when most people can return to activities. Your progress and goals may differ. Patience is advised.

Basic Return to Activity Timelines

  • Walking without crutches: two to six weeks.
  • Activities of daily living including stairs, moving around your home and personal care: four to eight weeks.
  • Riding an exercise bike: three to four weeks
  • Running: not before 10 to 14 weeks. Begin by walking, then progress to jogging and then running—if pain and swelling remain controlled.

When Can I Return to My Sport?

Most people can expect to return to their sport in eight to 10 months. Your timing depends on your injuries, your sport and meeting criteria set by your rehabilitation team. You need to reduce pain and swelling, achieve sufficient range of motion and regain strength. Your body also needs to reacquire the ability to sense position and movement (proprioception), which may have been impacted by your surgery.

For these reasons and to reduce your risk of a retear or injury to your other (contralateral) knee, specific return-to-sport training is advised.

Why ACL Rehabilitation Phases?

The MOON Knee rehabilitation program moves you from Phase 1 to Phase 5. Each phase has goals and instructions on how to attain those goals so that you can move to the next phase.

Evidence shows that targeting specific areas of the knee and leg in each phase leads to success.

For the rehabilitation to succeed, you need to complete one phase before moving to the next. Without acquiring the functionality and strength in the previous phase, you will fail at the next. The phases are also designed to protect the healing of the graft.

Your physician, physical therapist or athletic trainer will instruct you on when to advance to the next phase.

How Do I Maintain My Reconstructed Knee Over My Lifetime?

There is no research on maintaining your reconstructed ACL over a lifetime. However, common sense and nearly all medical and training professionals advise maintaining strength, range of motion and fitness (non-impact aerobic exercise).

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