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 0-8: (Beginning POD 0)
WB:
TTWB x 6 weeks and progress to PWB x 2 weeks (at week 6)
Brace/ROM:
Brace and ROM parameters dependent on other procedures performed
If only DFO performed brace 0-90 x 6 weeks and ROM 0-90 x 2 weeks then progress to full flexion
Focus should be on obtaining full extension ASAP, symmetric to contra-lateral side
Therapeutic Exercises:
- Swelling control (Including GameReady and patient ed)
- Quad sets ensuring proper form
- SLR’s in brace that can be started when able to tolerate
- Gentle HS and calf stretches
Patellar mobilizations: Use gentle soft tissue techniques for areas such as anterior interval/fat pad, quadriceps, hamstrings, and scar management
Hip and core exercises as tolerated
Begin stationary Biking as long as flexion >110 at week 6
No open or closed chain exercises of the lower extremity until POW 6 with exception of SLR’s in brace that can be started when able to tolerate
Phase 2 (weeks 8-24):
WB:
Can begin WBAT (no sooner than week 8) as permitted by MD
Can d/C crutches when WB restriction period ends as long as >/= 0° knee extension & 90° knee flexion, minimal effusion, and can ambulate without a limp
Therapeutic Exercises:
- Begin bilateral, non WB proprioception exercises and gradually progress to SL and WB as tolerated
- Gradual squat progressions as follows: DL leg press, DL mini squats, DL chair squats, DL body weight squats, SL leg press, SL step ups, Static lunge split squat, SL step downs, SL squats
- Core exercises, TKEs, calf raises, HS curls, hip machine (abduction), bridges
Week 20: can begin light barbell squats as long as FROM
Criteria to be met before advancing to Phase 3:
- symmetric knee extension and flexion
- Minimal effusion and pain
- Quad and HS strength at least 75% normal
- Can perform SL squat with good form for at least 1 minute
Phase 3 (week 24+):
Initiate jogging and progress to in-line running
- Begin on Zero G progressing to regular treadmill as tolerated 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.
Athletes:
Week 24-28: Strength, agility and DL Plyos:
- advance barbell squats, deadlifts, Olympic lifts
- Ladder drills, footwork agility drills, cone drills
- Double leg plyos: jump rope, line jumps, cone jumps, depth jumps, box jumps
- High intensity predictable patterned movements, incorporate sport specific drills
Week 28+: Advanced strengthening, agility, and initiation of speed work, SL plyo’s.
Criteria to begin advanced agility and plyos:
- Quad & HS strength > 80% normal
- > 50% H/Q ratio for females
- can perform at least 3 minutes of resisted single leg squats
- able to jog on track for 15 minutes or greater with minimal pain and swelling
Exercises:
- Continue to advance barbell squats, deadlifts, begin Olympic lifts
- Dynamic eccentric loading: double & single leg
- Dynamic core: rotational and anti-rotational drills
- Tuck jumps, squat jumps, bounding, SL hop, SL triple hop, SL cross over hop
- Change of direction drills: begin with < 90°, progress to 90° and greater
- Introduce unpredictable agility movements
- Non-contact sports specific drills
- Begin track workouts: gradually advance linear speed and sprinting drills
Progression through all sport specific drills including unpredictable agility and cutting and complex movement patterns.
Advance strengthening, speed, and conditioning to performance level preparedness.
Max effort DL and SL jumps
Can begin RTP progression at 6 months for non-contact sports and at 9 months for contact sports 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