Synthetic Graft Rehabilitation Protocol: Step-by-Step Exercise Program & Arthrometer Testing Guide

Traverse your ACL reconstruction recovery with our structured synthetic ACL rehabilitation protocol. Delve into exercises for each phase, from initial healing to advanced training, with arthrometer test schedules to assess knee stability. It is important to be cautions following an allograft surgery because of the integration of the tendon which is a bit slower compared to autograft.


Early Stage Post-Operative Rehabilitation (Weeks 1-2) - Synthetic ACL Rehabilitation Protocol


  • Control inflammation and swelling.
  • Achieve full knee extension.
  • Restore quadriceps function.
  • Maintain mobility in other joints.


Perform exercises 3-4 times per day.

GNRB or Dyneelax Test: No

NEVER PERFORMED during this phase to avoid additional stress on the ACL graft.

Too Early

It is too early to perform an arthrometer test on the graft at this stage

Quadriceps Sets:

  • Lie on your back with legs straight.
  • Tighten the muscle on the top of your thigh by pressing the back of your knee flat down into the floor.
  • Hold for 5 seconds, then relax.
  • Repeat 10-15 times.

Straight Leg Raises:

  • Continue lying on your back.
  • Keep your operated leg straight, tighten your quadriceps, and slowly raise the leg about 6 inches off the ground.
  • Hold for 5 seconds, then slowly lower back down.
  • Repeat 10-15 times.

Ankle Pumps:

  • While lying down or sitting, move your ankle up and down, mimicking the motion of pressing and releasing a gas pedal.
  • Perform this continuously for 2-3 minutes.

Gentle Knee Bends:

  • While sitting in a chair, gently slide your foot backward under the chair to bend the knee.
  • Go only to the point of comfort, not pain.
  • Hold for a few seconds, then slide the foot forward to return to the starting position.
  • Repeat 10-15 times.

Patellar Mobilizations:

  • Slide your heel towards your buttocks, bending your knee.
  • Hold for 5 seconds; repeat 10-20 times.

Intermediate Stage Post-Operative Rehabilitation (Weeks 3-6):


  • Improve range of motion.
  • Strengthen muscles around the knee.
  • Basic proprioception training.


Perform exercises 2-3 times per day.

GNRB or Dyneelax Test: Safe at Week 4

Translation Test: Yes, but maximum push 100N
Rotation Test: Yes, but maximum torque 3N/m

Walking applies 300N to the graft, so a 100N translation test at 6 weeks is safe. Yet, no rotation test should be conducted then.
Arthrometer tests performed at this stage will indicate if it is safe to perform certain type of exercises.

Mini Squats:

  • Stand with your feet shoulder-width apart.
  • Slowly bend your knees, lowering your body only a few inches. Keep your back straight.
  • Hold for a few seconds, then return to the starting position.
  • Repeat 10-15 times.


  • Find a stable step or platform.
  • Step up with your operated leg, then bring your other leg up to the same step.
  • Step down in reverse order.
  • Repeat 10-15 times.

Stationary Bike Riding:

  • Use a stationary bike with low resistance.
  • Start with 5-10 minutes and gradually increase to 20-30 minutes as tolerated.

Hamstring Curls:

  • While lying on your stomach, slowly bend your knee to bring your heel towards your buttocks.
  • Use a light ankle weight if possible.
  • Repeat 10-15 times.

Gentle Knee Flexion and Extension Exercises:

  • While sitting in a chair, gently bend and straighten your knee as far as comfortable.
  • Repeat 10-15 times.

Basic Balance Exercises:

  • Stand on one leg, using a chair or wall for support if needed.
  • Hold the position for 30 seconds to 1 minute.
  • Repeat 3-5 times with each leg.

Discover Proven Outcomes

Case Studies

Read the following study to understand the importance of using arthrometers after ACL Reconstruction surgeries. These allow to personnalize the rehabilitation programs of each patient to maximise the chances of success of the surgery and rehab!

Sports Medicine Technology: a therapist holding the knee of a patient. synthetic acl rehabilitation protocol. BPTB Rehabilitation Protocol. Hamstring Tendon Rehabilitation Protocol.
2017 - ACL Grafts Compliance During Time: Influence of Early Solicitations on the Final Stiffness of the Graft after Surgery

DOI: 10.24966/ORP-2052/100035
Stéphane Nouveau, Henri Robert, Thimothee Viel,

Late Stage Post-Operative Rehabilitation (Weeks 7-12):


  • Enhance muscle strength
  • Improve balance and proprioception.
  • Begin functional and sport-specific training under supervision.


Perform exercises 1-2 times per day.

GNRB or Dyneelax Test: Week 12

Translation Test: Yes, but maximum push 134N
Rotation Test: Yes, but maximum torque 3N/m

A test may be repreated around week 12 to monitor changes in knee joint laxity and provide feedback on the progress of rehabilitation. Walking applies 300N to the graft, so a 134N translation test is safe. Yet, no rotation test should be conducted then.
Arthrometer tests performed at this stage will indicate if it is safe to perform certain type of exercises.

Leg Presses:

  • Use a leg press machine, starting with light resistance.
  • Focus on a smooth, controlled movement.
  • Perform 3 sets of 10-15 repetitions, gradually increasing the weight as strength improves.

Forward and Side Lunges:

  • Step forward or sideways into a lunge, keeping your knee aligned with your foot.
  • Push back to the starting position.
  • Perform 10-15 lunges on each leg.

Advanced Balance Exercises:

  • Use a Bosu ball or balance board.
  • Stand on the unstable surface on one leg, trying to maintain balance.
  • Hold for 30 seconds to 1 minute, repeat 3-5 times with each leg.

Controlled Plyometric Drills:

  • Include low-intensity jumping exercises such as box jumps or skipping.
  • Focus on soft landings and proper form.
  • Start with 2 sets of 10 repetitions, gradually increasing intensity.

Agility Drills:

  • Incorporate ladder drills, cone drills, or similar exercises.
  • Focus on quick, agile movements with direction changes.
  • Perform drills for 5-10 minutes, ensuring good technique.

Continued Cardiovascular Training:

  • Continue with low-impact activities like cycling or swimming.
  • Aim for sessions of 20-30 minutes, focusing on building endurance.

Advanced Stage Post-Operative Rehabilitation (Months 4-6):


  • Return to sport-specific training.
  • Improve endurance, strength, and agility.
  • Enhance neuromuscular control.


Perform exercises 1-2 times per day or as recommended by your physical therapist.

GNRB or Dyneelax Test: Month 4

Translation Test: Yes, but maximum push 150N
Rotation Test: Yes, but maximum torque 3N/m

Month 5: Transaltion test at 200N Maximum.
Rotation Tests may also be performed starting Month 5.
Arthrometer tests are performed to assess readiness for a return to sports and to compare with pre-surgical measurements.

Sport-Specific Drills:

  • Gradually reintroduce drills specific to your sport, focusing on technique.
  • Begin with lower intensity and increase as tolerated.
  • Pay close attention to form and knee stability.

Advanced Plyometrics:

  • Include higher-intensity jumping exercises such as jump squats, bounding, or single-leg hops.
  • Focus on controlled landings and explosive movements.
  • Start with 2 sets of 10 repetitions and progress as able.

High-Intensity Strength Training:

  • Perform exercises like heavy squats, deadlifts, or leg presses, as tolerated.
  • Prioritize good form and controlled movements.
  • Aim for 3 sets of 8-12 repetitions.

Endurance Training:

  • Engage in running, cycling, swimming, or other aerobic exercises.
  • Gradually increase the intensity and duration to build cardiovascular endurance.

Advanced Balance and Proprioception Drills:

  • Perform challenging balance exercises, possibly incorporating unstable surfaces or dynamic movements.
  • Include exercises that mimic sport-specific scenarios.
  • Repeat 3-5 times with each leg, focusing on maintaining knee stability.

Maintenance Stage Post-Operative Rehabilitation (6 months onwards):


  • Maintain strength, flexibility, and functional stability.
  • Continue sport-specific training and conditioning.
  • Prevent re-injury through education and training.


Perform exercises and training routines as part of your regular fitness regimen, typically 3-5 times per week.

Arthrometer Testing:

As recommended by the physical therapist or orthopedic surgeon to monitor knee stability over time. Typically, this could be done annually or bi-annually depending on individual circumstances.


GNRB or Dyneelax Test: Month 6

Translation Test: Yes, any forces
Rotation Test: Yes, any torques

Last Tests should be done on Month 12.
Proper follow-up should be done to increase the chances of success of the ACL being stable again.

Continued Strength Training:

  • Engage in a regular routine of strength exercises such as squats, deadlifts, leg curls, and calf raises.
  • Aim to maintain or improve muscle strength around the knee and lower body.

Sport-Specific Skills Maintenance:

  • Regularly practice drills and skills specific to your sport.
  • Focus on maintaining technique and agility related to sporting movements.

Regular Flexibility and Balance Exercises:

  • Incorporate stretching routines to maintain muscle flexibility and joint range of motion.
  • Perform balance exercises like standing on one leg, yoga, or using a balance board.

Cardiovascular Fitness Maintenance:

  • Continue with cardiovascular activities such as running, cycling, or swimming.
  • Maintain or improve endurance to support overall fitness and knee health.

Education on Injury Prevention Strategies:

  • Stay informed about techniques and training modifications to prevent re-injury.
  • Include warm-ups and cool-downs in your routine, and understand the signs of overtraining.

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