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):
Root repairs and radial tear repairs
- WB: TTWB x 6 weeks
- ROM/Brace:
- Weeks 0-4: full extension- 60 degrees flexion
- Weeks 4-6: full extension – 90 degrees
- Brace to be worn at all times x 6 weeks
Bucket handle repairs:
- WB: WBAT with brace locked in full extension only
- Brace/ROM:
- Weeks 0-4: Full extension – 60 degrees flexion
- Weeks 4-6: Full extension – 90 degrees
Other meniscus repair types:
- WB status, motion, and brace parameters will vary. Please see op report
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
- Static balance
- Beginning POW 4 can begin Double leg (DL) mini squats and leg press from 0° to 60° then progress to 90° as tolerated at POW 6
Phase 2 (weeks 6-12):
*No loaded flexion past 90 degrees*
- D/C crutches when >/= 0° knee extension & 90° knee flexion, can easily perform repetitive SLR without lag, minimal effusion, and can ambulate without a limp
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
- stationary bike and begin rowing machine
- Balance training: foam pad, balance board
- Instruct on dynamic warm-ups: frankenstein kicks, leg swings, knee hugs, heel sweeps, heel/toe walks, oil rigs, lateral lunge, hip rotation, inch worm, speed squats
- Swimming: straight kick, no flip turns
- Squat progression: bodyweight squats → single leg squats
Phase 3 (weeks 12-16):
Progression to jogging and in-line running
Goals to attain before initiation of jogging/in-line running:
- symmetric knee extension and flexion to 120
- Minimal effusion and pain
- Quad and HS strength at least 65% normal
- Can perform SL squat with good form for at least 1 minute
- Dynamic warm-ups: frankenstein kicks, leg swings, knee hugs, heel sweeps, heel/toe walks, oil rigs, lateral lunge, hip rotation, inch worm, speed squats
- integrate sport-specific warm up
- Swimming: straight kick, no flip turns
- 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
- Continue stationary bike and begin rowing machine
- Balance training: foam pad, balance board
- 12+ weeks-Treadmill walk/jog progressions: begin with 30”-1’ W/J intervals, advance jog time by 1 min each week until 15 minutes of jogging achieved
- 12+ Weeks – Double leg jump rope and shuttle jumps
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.
- 16+ Weeks:
- Advance to track workouts: jog straights & walk curves
- Progress to linear speed and sprinting drills
- SL strengthening: SL squats, sit to stands, ball slams, step ups/downs
Phase 4 (weeks 16-20):
Agility and Plyo’s
Criteria to begin agility and plyos:
- Quad & HS strength > 85% normal
- > 50% H/Q ratio for females
- Can perform at least 3 minutes of resisted single leg squats
- Jogging>15 minutes on treadmill with no pain or swelling
Agility and Plyos:
- 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
- Single leg landings: alternating, line jumps, hops → SL jumps
- High intensity predictable patterned movements, incorporate sport specific drills
- Continue to advance barbell squats, deadlifts, Olympic lifts
- Dynamic eccentric loading: double & single leg
- Dynamic core: rotational and anti-rotational drills
Advanced agility and plyo’s (begin when able to perform all of the above and criteria met):
- 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
Strength and conditioning:
- Dynamic warm up, sports specific warm up, Stationary bike, elliptical, swimming, & rowing machine
- May begin progressive advancement of gym training (barbell squats, deadlifts, Olympic lifts)
- Dynamic core exercises: mountain climbers, planks, pikes, pale off press
- Integrate interval strength circuits & work/rest timed intervals
- Intermittently increase the tempo of regular strengthening exercises to align with the timing requirements of jogging and jumping
Phase 5 (week 20+):
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 when following criteria is met and when approved by Dr Borque (will vary based on type of tear and extent of repair):
- > 75/100 on ACL-RSI survey
- 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
- Little to no swelling or pain
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