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 (0-6 weeks):
Brace: Dynamic PCL brace with ROM set at: 0-60 x 2 weeks then 0-90 x 4 weeks
ROM: Obtain full extension avoiding overpressure and posterior sag at knee
Flexion ROM OOB: 0-60 x 1 week then 0-90 x 3 weeks then gradual progression to full
WB: WBAT in full extension
Therapeutic Exercises:
*Avoid hamstring activation*
Week 0-4: Quad sets, E-stim, SLR, weight shifts, open chain quads
Week 4: Can begin DL leg press, step ups, and mini squats from 0-60
- Swelling control (Including GameReady and patient ed)
- Patellar mobilizations: Use gentle soft tissue techniques for areas such as anterior interval/fat pad, quadriceps, hamstrings, and scar management
Can begin walking without crutches at POW 6 if patient has symmetric gait without limp, is able to perform 30 SLR without lag, is able to perform 20 seconds of SL balance, and has full extension
Phase 2 (weeks 6-12):
ROM: Maintain extension and progress to full flexion
Therapeutic Exercises:
- Initiate proprioception exercises: foam pad, balance board
- No open chain HS strengthening
- Squat progressions from 0-60 as follows: DL leg press>DL mini squats> DL elevated chair squats> DL body weight squats> SL leg press> SL step ups> Static lunge split squat> SL step downs> SL squats> SL split squat with elevated back leg
- Core exercises
Criteria to be met before jogging and initiation of Phase 3:
- symmetric knee extension
- 120 degrees flexion
- Quad and HS strength 70% normal
- able to perform one minute single leg squats with good balance
Phase 3 (weeks 12-24):
- Progression to full gym strengthening and all squat and closed chain strengthening 0-90 including barbell squats
- May initiate deadlifts as well as progressive isolate HS strengthening
- Initiate stationary biking and rowing machine
- Initiate jogging with gradual progression of duration as tolerated
- Can begin swimming with straight kicks
Week 20: may introduce light, low-paced agility, ladder drills, double leg box jumps, and side shuffles
Criteria to advance to Phase 4: Plyometrics, advanced agility and sport-specific training:
- 24 weeks post op
- Quad strength 85% normal 50% H/Q Ratio for females
- Able to perform 2 minutes of SL squats with good balance
Phase 4 (week 24+):
Advanced agility, plyometrics and sport-specific training
- Continue to advance barbell squats, deadlifts, Olympic lifts
- Dynamic eccentric loading: double & single leg
- Dynamic core: rotational and anti-rotational drills
- Change of direction drills: begin with < 90°, progress to 90° and greater
- Introduce unpredictable agility movements
- Max effort box jumps
- Begin SL hops and progress to Max effort DL and SL jumps
- Non-contact sports specific drills
- Begin track workouts: gradually advance linear speed and interval sprinting drills
- Advance strengthening, speed, and conditioning to performance level preparedness.
Can begin RTP progression at 9 months as long as the following criteria is met:
- Quad & HS strength > 95% normal
- > 60% H/Q ratio for females
- 95% normal SL hop tests
- 95% normal Figure of 8, 5-10-5 pro agility test, & SL vertical jump
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