Physical therapy examination and management for a 48-year-old active military patient during the maximum protection phase of ACL reconstruction rehab: a case report




Bussell, Taylor

Journal Title

Journal ISSN

Volume Title


Angelo State University. Department of Physical Therapy.


Background and Purpose: Anterior Cruciate Ligament (ACL) tears are one of the most commonly treated orthopedic injuries. Individuals participating in high-demand sports or activities are at higher risk for ACL injury, including active military personnel. Post-surgical protocols with criterion-based phases have been established to promote effective physical therapy rehabilitation for eventual full return to activity. However, many factors can affect the outcomes after an ACL reconstruction. The purpose of this case report is to present the physical therapy examination and management for a patient during the Maximum Protection Phase of ACL reconstruction rehab and discuss factors that could affect prognosis and outcome, including military background and status, concomitant injury, time to surgery, and age. Case Description: A 48-year-old male active-duty Army sergeant was referred to outpatient orthopedic physical therapy clinic for post-operative management after undergoing a left ACL reconstruction with an anterior tibialis tendon allograft, lateral meniscus arthroscopy, and medial femoral condyle and patellar chondroplasty. Prior to surgery, he had experienced worsening, chronic left knee pain for three years that limited his military duties and recreational activities. Outcomes: The patient made notable improvements in swelling, knee range of motion (ROM), quadriceps activation, and gait through physical therapy intervention targeting these impairments. Additionally, he was able to tolerate progressions to closed kinetic chain (CKC) strengthening and Blood Flow Restriction (BFR). Discussion: Physical therapy intervention was beneficial in improving early post-operative impairments regardless of prognostic factors, including concomitant injury, age, time to surgery, or military status. Further research is needed to assess the effect of these factors on outcomes beyond the Maximum Protection Phase of rehab.



Anterior Cruciate Ligament Reconstruction, Physical Therapy, Maximum Protection Phase, Military