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)
WB: TTWB x 4 weeks then PWB x 2 weeks
Brace: 0-60 x 4 weeks then 0-90 x 2 weeks
ROM:
- Extension to symmetry ASAP
- Flexion as per brace parameters
Therapeutic Exercises:
- Swelling control (Including GameReady and patient ed)
- Focus should be on obtaining full extension, symmetric to contra-lateral side unless patient has hyper-laxity
- Quad sets ensuring proper form
- Straight leg raises with calf taps, ensuring constant quad contraction and minimizing lag
- Prone hangs, HS, 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 full ambulation at 6 weeks as long as patient has the following:
- 0 DEG KNEE EXTENSION & 90 DEG KNEE FLEXION
- > 30 STRAIGHT LEG RAISES WITHOUT LAG
- MINIMAL EFFUSION/PAIN, & SYMMETRICAL GAIT WITHOUT A LIMP
Phase 2 (weeks 6-24): Progressive Strengthening
*Avoid loading knee flexed past 60 for first 12 weeks*
- Leg press, step ups, step downs, RDLs, lunges, Bulgarian squats, wall sits
- Advance hip abduction & glut strength: band walks, lateral lunge, reverse lunge
- Core exercises: planks, side planks, v-ups, Russian twist, superman
- Begin stationary bike and straight kick swimming at 12 weeks and begin rowing machine at 16 weeks
- Balance training: foam pad, balance board
At week 20 can begin the following:
- Gym strengthening: squats, deadlifts
- SL strengthening: SL squats, sit to stands, ball slams, step ups/downs
- Dynamic core exercises: mountain climbers, planks, pikes, pale off press
Criteria to advance to Phase 3:
- PAIN LESS THAN 3 / 10 (WORST)
- Full symmetric knee extension & 120 DEG KNEE FLEXION
- QUADRICEPS & HAMSTRING STRENGTH > 60% NORMAL
- LESS THAN 4cm DEFICIT ON SINGLE-LEG SQUAT (ANTERIOR REACH)
- AT LEAST 1 MINUTE OF SINGLE LEG SQUATS
Phase 3 (months 6-9):
Weeks 24-28:
- Initiate zero-G walk/jog progressions, gradually advancing from 30 seconds: 1 minute intervals as tolerated
- Advance to regular treadmill and advance jogging duration gradually as tolerated
- Initiate double leg jump rope and shuttle jumps for athletes
- May continue progressive advancement of gym training (barbell squats, deadlifts, and begin Olympic lifts)
- SL strengthening: SL squats, sit to stands, ball slams, step ups/downs
- Dynamic core exercises: mountain climbers, planks, pikes, pale off press
- Integrate interval strength circuits & work/rest timed intervals
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
Agility and DL Plyos:
- Ladder drills, footwork agility drills, cone drills
- Double leg plyos: jump rope, line jumps, cone jumps, depth jumps, box jumps
- Advance to SL plyos as tolerated
Phase 4 (9 months) (Athletes):
- Double leg plyos: jump rope, line jumps, cone jumps, depth jumps, box jumps
- High intensity predictable patterned movements, incorporate sport specific drills then progress to 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 9 months for non-contact sports and at 12 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