Research

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Closed kinetic chain (CKC) quadriceps exercises are preferred over open kinetic chain (OKC) exercises in the first 6 weeks after ACL reconstruction with bone-patellar tendon-bone (BPTB) grafts, as OKC exercises may increase graft laxity.

If you had your ACL reconstructed with a bone-patellar tendon-bone graft, avoid open kinetic chain exercises (like straight leg extensions) for the first 6 weeks. Instead, focus on closed kinetic chain exercises (like squats or lunges) as they are safer for your graft and lead to better knee function. If you had a hamstring graft, you might be able to start limited open chain exercises after 4 weeks, but only within a specific range of motion.

WeakSupportsHIGH confidence
Andersson et al conclude in their systematic review (level A1) that after ACLR with BTPB, CKC quadriceps exercises produce less pain, less risk of increased laxity and better self-reported knee function compared to OKC quadriceps exercises.
Nicky van Melick et al. · British Journal of Sports Medicine · 2016

Why this rating

Based on Level A1 systematic reviews.

Source

Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus

Nicky van Melick et al. · British Journal of Sports Medicine · 2016

DOI 10.1136/bjsports-2015-095898

clinical_guidelineCited 874×
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DOI resolved against Crossref · corpus check 2026-06-10

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