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:
*The following parameters are for isolated OCT procedure and will vary if other procedures done
ROM:Extension to symmetry ASAP
Flexion: 0-90 x 4 weeks
WB: TTWB x 2 weeks then PWB x 2 weeks
Brace: advance with quad control
Week 0-2: 0-60 degrees
Week 2-4: 0- 90 degrees
Week 4-6: 0-120 degrees
Therapeutic exercise:
Beginning POW 0:
- 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
- Hip abduction exercises
- 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
POW 4:
- TKE’s, static DL balance, mini squats
- Stationary bike when achieve 110 degrees of flexion
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 6-16): Advance to full symmetric ROM
Therapeutic exercise:
- 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
- Continue balance training: foam pad, balance board
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 (week 16-24):
Jogging:
Week 16: Initiate zero-G walk/jog progressions, gradually advancing from 30 seconds: 1 minute intervals as tolerated
Week 20: Advance to regular treadmill and advance jogging duration gradually as tolerated
Strength and conditioning:
Week 16:
- May begin progressive advancement of gym training (barbell squats, deadlifts)
- 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
Week 20:
- Initiate double leg jump rope and shuttle jumps for athletes
Criteria to begin Phase 4 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
Phase 4 (weeks 24-32):
Initiation of basic agility and plyometrics and complex strengthening exercises:
- 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
Strength and conditioning:
- Initiate Olympic lifts
- Continue progressive full body gym training
- Begin gradual progression back to all track workouts
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
Phase 5 (weeks 32-36): Advanced agility and Plyometrics
Week 32:
- 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
- Initiate high intensity predictable movement patterns
Week 34:
- Introduce unpredictable agility movements
- Non-contact sports specific drills
Strength and conditioning:
- Continue to advance barbell squats, deadlifts, Olympic lifts
- Dynamic eccentric loading: double & single leg
- Dynamic core: rotational and anti-rotational drills
Phase 6 (Weeks 36+): Return to play
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 9 months for non-contact sports and 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