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)
Weight bearing status and brace dependent on other associated procedures done, please see Op report for instructions
ROM:
For HTO only may advance to full flexion as tolerated. 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
- 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
- No open or closed chain exercises of the lower extremity
- 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
Phase 2 (weeks 6-24):
Therapeutic Exercises:
- Begin bilateral, non WB proprioception exercises and gradually advance to SL and WB
- May begin open and closed chain exercises
- 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
- Begin stationary Biking as long as flexion >110
- 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