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 (0-8 weeks):
Brace: locked at 0 x 2 weeks then may increase brace gradually as quad control improves (goal to advance 15-30 degrees weekly)
WB: WBAT
ROM: 0-90 x 2 weeks then gradually advance to full flexion
Focus should be on obtaining full extension, symmetric to contra-lateral side ASAP
Therapeutic Exercises:
- Swelling control (Including GameReady and patient ed)
- 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
Weeks 0-2: Double leg (DL) mini squats and leg press from 0° to 30°
Weeks 2-8: Double leg (DL) mini squats and leg press from 0° to 60°
Begin proprioceptive exercises and stationary bike at week 3:
- double leg proprioception to start: static→foam/balance board, etc. then advance to single leg
- Core exercises: planks, side planks, v-ups, Russian twist, superman
- Begin gluteal exercises
- D/C crutches POW 5 as long as >/= 0° knee extension & 90° knee flexion, can easily perform repetitive SLR without lag, minimal effusion, and can ambulate without a limp
Week 6: Can begin RDL’s, resisted hip abduction, lateral band walks, progressive core exercises (V-ups, single leg bridging)
Phase 2 (weeks 8-12):
Progressive strengthening and preparation for running and agility
- Squat progression to 90 degrees (BODYWEIGHT SQUATS -> SINGLE LEG SQUATS)
- Squat progressions as follows: DL leg press, 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, walking lunges, SL sit to stands
- Begin elliptical and rowing machine post op week 10
Goals to attain before initiation of Phase 3 jogging/in-line running at POW 12:
- symmetric knee extension and flexion to 120
- Minimal effusion and pain
- Can perform SL squats with good form for at least 1 minute
Phase 3 (weeks 12-16):
Strengthening, running, and agility
- May begin progressive advancement of gym training (barbell squats, deadlifts, 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
- Intermittently increase the tempo of regular strengthening exercises to align with the timing requirements of jogging and jumping
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.
Basic Agility and DL 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
Criteria to begin advanced 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
- able to jog on track for 15 minutes or greater with minimal pain and swelling
Phase 4 (weeks 16+):
Return To Play
- 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 4 months 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