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ACL reconstruction rehabilitation review template

Criteria-based phases rather than calendar weeks, with strength and hop symmetry before return to sport.

What it is built on

  • Criteria-based progression. Melbourne ACL Rehabilitation Guide 2.0 (Cooper and Hughes, 2018)
  • Psychological readiness. ACL Return to Sport after Injury scale, ACL-RSI (Webster et al., 2008)

How to use it: Free Evidence-Based Physiotherapy Note Templates

Where they are

  1. Weeks since surgery Short answer
  2. Phase Choose one: Early: swelling, extension, quadriceps activation · Strength and control · Running and agility · Return to training · Return to sport
  3. Swelling and range of movement Written answer
  4. Pain today (0–10) Scale 0 to 10

Criteria for the next phase

  1. Quadriceps strength, injured side as % of the other Number
  2. Hamstring strength, injured side as % of the other Number
  3. Single-leg hop distance, injured side as % of the other Number
  4. ACL-RSI score Number
  5. Criteria for the next phase met Tick box Many protocols look for 90% or more symmetry before return to sport.

Treatment and plan

  1. Treatment and exercises today Written answer
  2. Plan and next review Written answer

A starting point, not clinical advice. Check that it fits your patients, your practice and the rules where you work before you use it.