Patient may progress to each phase as long as all goals met from previous phase. Please notify Dr Borque’s team if patient unable to perform any items specified.
Phase 1: WEEKS 0-6: (Beginning POD 0)
ROM:
Week 0-2: Obtain full symmetric hyperextension- 30 degrees flexion
Week 2-4: 0-60
Week 4-6: 0-90
WB:
Week 0-6: WBAT with brace locked in full extension
Brace:
Advance brace with ROM parameters but must be locked in full extension while ambulating
Therapeutic Exercises:
-Swelling control (Including GameReady and patient ed)
-Quad sets ensuring proper form
-Weight shifts
-Straight leg raises IN BRACE with calf taps, ensuring constant quad contraction and minimizing lag
-Prone hangs and calf stretches
-Patellar mobilizations: Use gentle soft tissue techniques for areas such as anterior interval/fat pad, quadriceps, hamstrings, and scar management
-Can Begin single leg balance at POW 4
CRITERIA FOR AMBULATION WITHOUT ASSISTIVE DEVICE:
AT LEAST 6 WEEKS POST-SURGERY
PAIN LESS THAN 3/10 (WORST)
WITHIN 2 DEG NORMAL KNEE EXTENSION & 75 DEG KNEE FLEXION
SINGLE LEG BALANCE > 20 SEC (BESS)
Phase 2 (Weeks 6-16):
ROM:
Week 6-8: 0-120
Week 8+: Gradually advance to full symmetric flexion, nothing forced
Therapeutic Exercises:
Week 6-8: MINI-SQUATS, SHORT ARC QUADS, LIGHT LEG PRESS PARTIAL RANGE, CORE EXERCISES (V-UPS, BRIDGING)
Weeks 8-12: Squat progressions as follows: DL body weight squats, DL leg press, DL mini squats, DL chair squats
Weeks 12-16: Initiate SL squats, barbell squats, deadlifts
-Begin stationary bike when >/= 110 flexion
Running prep exercises:
-focus on the deceleration phase such as DL speed squats, DL drop squats, DL “bounce, bounce, bounce squat”, then progress to alternating SL drop squats.
Initiate jogging and progress to in-line running:
-Begin on treadmill with 2- 3 days per week. Begin with 1:1 or 2:1 walk to jog ratios, (ie. 1 min walk to 1 min jog or 2 min walk to 1 min jog). Then progress each week by 1 min jog until 12-15 min of jogging is achieved.
Phase 3 (weeks 16-24):
Strengthening:
GYM STRENGTHENING (SQUATS, DEADLIFTS), CORE EXERCISES (MOUNTAIN CLIMBERS, PLANKS, V-UPS)
May begin Olympic lifts at 20 weeks
Conditioning:
Biking, swimming, Jogging, Elliptical, Rowing
Plyometrics and Light Agility:
Week 16: - LADDER DRILLS, DOUBLE LEG HOPS, SIDE SHUFFLE
Week 20: SINGLE LEG BOX JUMPS & HOPPING, LIGHT AGILITIES
Continue to advance predictable movement pattern drills as tolerated and able
CRITERIA FOR HEAVY AGILITY & SPORT SPECIFIC MOVEMENTS:
Phase 4 (Weeks 24+):
Heavy Agility, Plyometrics, Sport-specific Movements
Therapeutic Exercises:
-Continue to advance barbell squats, deadlifts, Olympic lifts
-Dynamic core: rotational and anti-rotational drills
-Begin track workouts: gradually advance linear speed and sprinting drills
-Advance strengthening, speed, and conditioning to performance level preparedness.
Plyometrics:
-Dynamic eccentric loading: double & single leg
- Tuck jumps, squat jumps, bounding, SL hop, SL triple hop, SL cross over hop
-Max effort DL and SL jumps
-Max effort box jumps (progress with rotation)
Agility:
-Introduce unpredictable movement patterns and change of direction drills: begin with < 90°, progress to 90° and greater advancing as tolerated and able
-Progression through all sport specific drills including unpredictable agility and cutting and complex movement patterns.
-Unpredictable contact drills
Can begin RTP progression at 6 months as long as the following criteria is met:
-Quad & HS strength > 95% normal
- > 60% H/Q ratio for females
-Can to 3 minutes of SL squats
- 95% normal SL hop tests
-95% normal Figure of 8, 5-10-5 pro agility test, & SL vertical jump
- MD OR PA APPROVAL
If all of the above met will advance with return to practice → return to contact practice → return to scrimmage → return to interval play →return to full play