Delayed Rehabilitation After ACL Reconstruction: Phase III–IV Physiotherapy Case Report

Zaenal Muttaqqin; Wijianto; Halim Mardianto

doi:10.24843/

Authors

Zaenal Muttaqqin Professional Program in Physiotherapy, Universitas Muhammadiyah Surakarta, Surakarta, Indonesia Author
Wijianto Professional Program in Physiotherapy, Universitas Muhammadiyah Surakarta, Surakarta, Indonesia Author
Halim Mardianto Department of Physiotherapy, KRMT Wongsonegoro Hospital, Semarang, Central Java, Indonesia Author

DOI:

https://doi.org/10.24843/

Keywords:

Anterior Cruciate Ligament Reconstruction, Rehabilitation, Postural Balance, Muscle Strength, Physical Therapy Modalities

Abstract

Background: Delayed rehabilitation after anterior cruciate ligament reconstruction (ACLR) may result in persistent pain, muscle weakness, impaired balance, and functional limitations despite successful surgical healing. Evidence regarding advanced physiotherapy management in patients who initiate rehabilitation several months after surgery remains limited.
Objective: To describe the clinical outcomes of Phase III and transitional Phase IV physiotherapy rehabilitation in a patient with delayed recovery following ACLR.
Methods: This case report involved a 17-year-old male who underwent right ACLR using a hamstring tendon autograft and did not receive structured physiotherapy for approximately seven months after surgery. A four-week criterion-based rehabilitation program (eight sessions) consisting of strengthening, proprioceptive, neuromuscular, balance, and agility exercises was implemented. Outcomes included Numeric Rating Scale (NRS), knee range of motion (ROM), muscle strength, thigh muscle girth, and Y Balance Test performance.
Results: Movement pain decreased from 7/10 to 2/10, while resting and tenderness pain resolved completely. Knee flexion ROM improved from 140° to 145°. Hamstring strength increased from 110 mmHg to 130 mmHg (+18.2%). Thigh girth increased by 2 cm at all measurement sites. Y Balance Test composite score improved from 76% to 89% (+17.1%), indicating enhanced dynamic balance and neuromuscular control.
Conclusion: Criterion-based Phase III and transitional Phase IV rehabilitation was associated with improvements in pain, hamstring strength, muscle girth, dynamic balance, and functional performance in a patient who initiated rehabilitation seven months after ACLR.