PHYSIOTHERAPY MANAGEMENT OF PHASE II REHABILITATION POST ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION: OPTIMIZATION OF MUSCLE STRENGTH AND RANGE OF MOTION OF THE KNEE JOINT
DOI:
https://doi.org/10.61677/jth.v3i3.741Keywords:
ACL reconstruction, phase II rehabilitation, weight-bearing exercise, knee functionAbstract
Anterior cruciate ligament (ACL) injury is one of the most common knee ligament injuries among physically active adolescents, particularly in sports requiring frequent pivoting and landing such as basketball. Functional outcomes following ACL reconstruction are strongly influenced by the quality of postoperative physiotherapy, especially during Phase II rehabilitation, which serves as a transition toward higher functional activities. This study aimed to evaluate the outcomes of Phase II physiotherapy management incorporating progressive weight-bearing exercises on muscle strength, knee range of motion, pain, and functional performance in an adolescent patient after ACL reconstruction. A case report design was applied to a 17-year-old female patient following anterior cruciate ligament reconstruction (ACLR). The intervention program consisted of progressive strengthening exercises (mini squats and lunges), balance and stability training, range of motion exercises, and functional task-oriented training. Outcome measures included muscle strength assessed using a sphygmomanometer, knee range of motion measured with a goniometer, pain intensity evaluated using the Visual Analogue Scale (VAS), and functional performance assessed using the Lysholm Knee Scoring Scale (LKSS). The results demonstrated improvements in quadriceps strength (145–210 mmHg) and hamstring strength (130–155 mmHg), restoration of full knee extension (−5° to 0°), increased knee flexion to 145°, decreased pain intensity (VAS 4 to VAS 1), and improved functional performance (LKSS 79 to 92). Phase II physiotherapy incorporating progressive weight-bearing exercises resulted in clinically meaningful improvements in knee function and prepared the patient for advanced rehabilitation phases.
References
Ardern, C. L., Ekås, G. R., Grindem, H., Moksnes, H., Anderson, A. F., Chotel, F., Cohen, M., Forssblad, M., Ganley, T. J., Feller, J. A., Karlsson, J., Kocher, M. S., Laprade, R. F., Mcnamee, M., Mandelbaum, B., Micheli, L., Mohtadi, N., Reider, B., Roe, J., … Engebretsen, L. (2018). 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. British Journal of Sports Medicine, 52(7), 422–438. https://doi.org/https://doi.org/10.1136/bjsports-2018-099060
Arora, H., Kalra, S., & Sharma, M. (2025). The Influence of Quadriceps-to-Hamstring Strength Ratio on ACL Stability. International Journal of Advanced Research (IJAR), 13(02), 1441–1448. https://doi.org/10.21474/IJAR01/20512
Briggs, K. K., Lysholm, J., Tegner, Y., Rodkey, W. G., Kocher, M. S., & Steadman, J. R. (2009). The Reliability, Validity, and Responsiveness of the Lysholm Score and Tegner Activity Scale for Anterior Cruciate Ligament Injuries of the Knee: 25 Years Later. The American Journal of Sports Medicine, 37(5), 890–897. https://doi.org/https://doi.org/10.1177/0363546508330143
Buckthorpe, M. (2019). Optimising the Late-Stage Rehabilitation and Return-to-Sport Training and Testing Process After ACL Reconstruction. Sports Medicine, 49(7), 1043–1058. https://doi.org/https://doi.org/10.1007/s40279-019-01102-z
Filbay, S., Andersson, C., Gauffin, H., & Kvist, J. (2021). Prognostic Factors for Patient-Reported Outcomes at 32 to 37 Years After Surgical or Nonsurgical Management of Anterior Cruciate Ligament Injury. Orthopaedic Journal of Sports Medicine, 9(8), 23259671211021590. https://doi.org/https://doi.org/10.1177/23259671211021592
Gokeler, A., Neuhaus, D., Benjaminse, A., Grooms, D. R., & Baumeister, J. (2019). Principles of Motor Learning to Support Neuroplasticity After ACL Injury: Implications for Optimizing Performance and Reducing Risk of Second ACL Injury. Sports Medicine, 49(6), 853–865. https://doi.org/https://doi.org/10.1007/s40279-019-01058-0
Greenberg, E. M., Watson, A., Helm, K., Landrum, K., Lawrence, J. T. R., & Ganley, T. J. (2025). Precision Rehabilitation After Youth Anterior Cruciate Ligament Reconstruction: Individualized Reinjury Risk Stratification and Modifiable Risk Factor Identification to Guide Late-Phase Rehabilitation. The Orthopaedic Journal of Sports Medicine, 13(4), 1–9. https://doi.org/10.1177/23259671251329355
Hagen, M., Vanrenterghem, J., Borne, Y. Van Den, Diaz, M. A., Verschueren, S., & Robinson, M. A. (2025). Hamstrings and Quadriceps Weaknesses Following Anterior Cruciate Ligament Reconstruction Persist Up to 6 Months After Return-to-Sport : An Angle-specific Strength Analysis. International Journal of Sports Physical Therapy, 20(2), 176–188. https://doi.org/10.26603/001c.128505
Haidar, M. D., Mulyawan, R., Dewantara, J., & Jurek, J. M. (2025). Rehabilitation of the knee following ACL repair and reconstruction: A review of clinical best practices. Tanjungpura Journal of Coaching Research, 3(1), 41–55. https://doi.org/https://doi.org/10.26418/tajor.v3i1.88592
Hawker, G. A., Mian, S., Kendzerska, T., & French, M. (2011). Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF. Arthritis Care & Research, 63(Suppl 11), S240–S252. https://doi.org/10.1002/acr.20543
Hayati, N., Rahayu, U. B., & Mardianto, H. (2024). Exercise For Rehabilitation After ACL Recontruction To Improve Neuromuscular & Strenght And Return To Sport. Jurnal Medika Nusantara, 2(1), 133–139. https://doi.org/https://doi.org/10.59680/medika.v2i1.905
Herman, M., & Komalasari, D. R. (2022). Penatalaksanaan Fisioterapi Post Operative Anterior Cruciate Ligament: Studi Kasus. Physiotherapy Health Science (PhysioHS), 4(1), 31–36. https://doi.org/https://doi.org/10.22219/physiohs.v4i1.21862
Högberg, J., Piussi, R., Lövgren, J., Wernbom, M., Simonsson, R., Samuelsson, K., & Senorski, E. H. (2024). Restoring knee flexor strength symmetry requires 2 years after ACL reconstruction, but does it matter for second ACL injuries? A systematic review and meta-analysis. Sports Medicine-Open, 10(2), 1–22. https://doi.org/https://doi.org/10.1186/s40798-023-00666-5
Longo, U. G., Salvatore, S. De, Orrico, F. D., Bella, M., Corradini, A., Rizzello, G., Marinis, M. G. De, & Denaro, V. (2023). The Impact of Psychological Factors on Return to Sports after Anterior Cruciate Ligament Reconstruction : A Systematic Review. Osteology, 3(3), 78–93. https://doi.org/https://doi.org/10.3390/osteology3030009
Mashreghi, D., Fakoor, M., Arti, H., Mohammadhoseini, P., Goharpey, S., & Farhadi, E. (2024). Investigating the effective factors on rehabilitation in anterior cruciate ligament reconstruction based on Lysholm knee score. Journal of Advanced Pharmacy Education and Research, 14(3), 43–48. https://doi.org/https://doi.org/10.51847/W4m2xHgTH7
Norkin, C. C., & White, D. J. (2016). Measurement of joint motion: a guide to goniometry (5th ed.). FA Davis.
Palmieri-Smith, R., & Lepley, L. (2016). Quadriceps strength asymmetry following ACL reconstruction alters knee joint biomechanics and functional performance at time of return to activity. The American Journal of Sports Medicine, 43(7), 1662–1669. https://doi.org/10.1177/0363546515578252.Quadriceps
Riley, D. S., Barber, M. S., Kienle, G. S., Aronson, J. K., Schoen-Angerer, T. von, Tugwell, P., Kiene, H., Helfand, M., Altman, D. G., Sox, H., Werthmann, P. G., Moher, D., Rison, R. A., Shamseer, L., Sun, C. A. K. G. H., Hanaway, P., Sudak, N. L., Kaszkin-Bettag, M., Carpenter, J. E., & Gagnier, J. J. (2017). CARE guidelines for case reports: explanation and elaboration document. Journal of Clinical Epidemiology, 89, 218–235. https://doi.org/10.1016/j.jclinepi.2017.04.026
Silva, B. B. C., Venturato, A. C. T., Aguiar, L. T., Filho, L. F. R. M., Faria, C. D. C. M., & Polese, J. C. (2019). Validity and reliability of the Modified Sphygmomanometer Test with fixed stabilization for clinical measurement of muscle strength. Journal of Bodywork and Movement Therapies, 23(4), 844–849. https://doi.org/https://doi.org/10.1016/j.jbmt.2019.05.008
Sundberg, A., Högberg, J., Tosarelli, F., Buckthorpe, M., & Villa, F. Della. (2025). Sport‑Specific Injury Mechanisms and Situational Patterns of ACL Injuries: A Comprehensive Systematic Review. Sports Medicine, 55(10), 2489–2527. https://doi.org/10.1007/s40279-025-02271-w
Vitaloka, D. A., Wijianto, & Mardianto, H. (2023). Manajemen fisioterapi dalam meningkatkan keterbatasan LGS dan kekuatan otot pada kasus post OP fase 2 di RSUD KMRT Wongsonegoro Semarang: Studi kasus. Jurnal Cakrawala Ilmiah, 2(11), 4265–4272. https://doi.org/https://doi.org/10.53625/jcijurnalcakrawalailmiah.v2i11.6124
Willinger, L., Athwal, K. K., Holthof, S., Imhoff, A. B., Williams, A., & Amis, A. A. (2023). Role of the Anterior Cruciate Ligament, Anterolateral Complex, and Lateral Meniscus Posterior Root in Anterolateral Rotatory Knee Instability A Biomechanical Study. The American Journal of Sports Medicine, 51(5), 1136–1145. https://doi.org/10.1177/03635465231161071
Wu, J., Kator, J. L., Zarro, M., & Leong, N. L. (2022). Rehabilitation Principles to Consider for Anterior Cruciate Ligament Repair. Sports Health, 14(3), 424–432. https://doi.org/10.1177/19417381211032949
Yahya, A. M., & Alpiah, D. N. (2026). Efektivitas Terapi Latihan Pada Pasien Post-Op Rekontruksi ACL: Literatur Review. Jurnal Ilmiah Nusantara, 3(2), 169–176. https://doi.org/https://doi.org/10.61722/jinu.v3i2.8585
Zhou, W., Liu, X., Hong, Q., Wang, J., & Luo, X. (2024). 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, 12, e17279. https://doi.org/https://doi.org/10.7717/peerj.17279
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 JTH: Journal of Technology and Health
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
