1.Pre-op exercises usually depend on the amount of pain, ROM restriction and frequency of instability episodes. Assuming that you patient has no MCL and/or meniscal injuries with minimal pain and ROM issues, he can work at building the strength of his quadriceps, hamstrings and calves with both open and closed kinetic chain strengthening exercises. Since there is no ACL to speak of, open kinetic chain (OKC) exercises may be used if weight bearing is painful. A common pre-op programme may include 15-30 minutles cycling followed by strengthening exercises. Aqua jogging and swimming may be considered to maintain cardiovascular fitness. Jogging/running may be permitted if pain and instability are not an issue.

2. I do not think the type of graft will determine the time taken to return to sports. It is debatable whehter hamstring or patellar graft is superior over another.

3. Full or near full function as far as ADLs are concerned can be achieved in 4-6 weeks post-op. Most surgeons would be able to provide a post-op ACL rehab protocol of their preference. A good reference text is Clincal Sports Medicine by Brukner & Khan.

4.I think you have already outlined the realistic timeframe for his return to sports (i.e. running, squash and rugby). Although he may be able to return to jogging/running fairly soon, strong acceleration and decelearation type activity such as squash may not be possible for 6 months as the graft may fail. Graft failure is usually a good incentive for most patients to adhere to the programme but there are always exceptions. The general rule of thumb is that one cannot hurry nature.