Brace: Dynamic PCL brace with ROM set at: 0-60 x 2 weeks then 0-90 x 4 weeks
IF LCL/PLC repair/recon: 0-30 x 2 weeks, 0-90 x 4 weeks
ROM: Obtain full extension avoiding overpressure and posterior sag at knee
Flexion ROM (IN PRONE POSITION) OOB: 0-60 x 1 week then 0-90 x 3 weeks then gradual progression to full
WB: WBAT in full extension
IF LCL/PLC repair/recon: TTWB x 2 weeks, PWB x 2 weeks, WBAT POW 4
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
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 ONLY 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
minimal effusion
120 degrees flexion
Quad and HS strength 70% normal
able to perform one minute single leg squats with good balance
Progression to full gym strengthening and all squat and closed chain strengthening 0-90 including barbell squats
May initiate deadlifts as well as progressive isolated HS strengthening
Initiate stationary biking and rowing machine
Initiate jogging with gradual progression of duration as tolerated:
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.
Initiate jogging and progress to in-line running:
-Begin on treadmill 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.
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
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:
- > 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
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