TIME POST-OP

Progression of program

Additional if tolerated

Stage I

Day 1 to Day 14

Evaluation and review of Home Exercise Program. Begin weaning from crutches to increase Weight Bearing.

Partial Weight bearing to full weight bearing as tolerated.

Active range of motion aiming for full knee extension by 14 days.

Patella mobilisations to maintain patella mobility.

Gait retraining with full extension at heel strike.

Early active hamstring beginning with static weight bearing co-contractions (Closed Kinetic Chain)

Gentle hamstring strengthening.

Stage II

Week 2 - Week 3

Re-evaluation and review of Home Exercise Program.

Aim for full range of motion. 

Emphasis on VMO (vastus medialis obliquus  quad) control with all exercises, progress to leg press, stationary bike and Theraband squats.

Commence swimming once wound has healed.

Hamstring strengthening progress complexity and repetitions of co-contractions.

Week 3 – Week 4

Reinforce quad leg control and timing in closed chain activities. Initiate aquatic exercise.

Advanced gait training: marching, retro walking, sidestepping.

Progress bilateral hamstring curls to low resistance single curls and step-down

Week 4

Progression of exercises  to emphasize single leg workouts with increased weight as tolerated. Re-evaluate after 4 weeks to determine if the patent is appropriate for weaning to 2 PT sessions per week and 1 independent session in Fitness program.

Low resistance high repetition weight program aim to increase hamstring muscle endurance.

Care must be taken as hamstring stains may occur and restrict further progression.

Continue with hamstring stretches.

Add Smith press, Stairmaster and focus on PRE’S with single legwork on machines.

The following criteria to be evaluated:

-Ability to single leg stand 30 sec.
-No antalgia (limping) on level surfaces.
-Normal ascend and minimal assist descending stairs.
-ROM (range of motion) 0-115° with minimal discomfort.
-Minimal to no pain or swelling with current program

Week 5

Continue to progress Progressive Resistance

Exercise (PRE’s).

Walk-through low-level functional/agility exercises-those with no impact, twisting, or turning.

Progress to trunk/sport cord challenges (manual resistance to trunk with walking, side stepping etc.).

Single leg stand LE reach (ground clock)

Week 6

Shallow and deep water jogging is acceptable.

Low-level functional/agility at low speed and impact. No cutting or twisting.

Increase resistance on trunk challenges.

Discontinue low level exercises and wean from HEP control ex’s while progressing aerobic, gym PRE’s, and functional/agility exercises.

Eccentric hamstring strengthening is progressed as pain allows.

Stress to patient graft is not mature and must be aware of functional restrictions to avoid risk of graft failure

Treadmill walking with slight incline only if tolerated.

Stage III

Week 8 – week 12

Progress to more dynamic activities /movements. I.e.: step lunge and half squats.

Proprioceptive work, i.e.: lateral stepping and slide boards.

The following functional test can be used to assist in making that decision: Ability to do 4" step down. PROM (passive range of motion) 0-125° with full active extension. Low speed low-level agility without pain. Ability to perform current exercise program without pain or swelling.

At 8-week visit, continue to progress aerobic, gym exercises. This is the earliest cut-off to start a jogging progression.

Week 10

Continue with current program progressing as tolerated. Progress jogging program to straight line jogging on the flat.

Increase speed on low-level functional/agility and progress to intermediate functional activity. Aggressive resistance with trunk challenges and sport cord.

Start cycling on normal bicycle.

Continue with static control but emphasis on endurance. I.e.: wall squats.

Examples of intermediate functional activity: Quick steps, two leg hopping, vertical leaps

Week 12

Review program and parameters.

Stage IV

Week 12 – 5 months

Data will be recorded. Review program and increase intensity exercises If ROM is normal and patient is progressing with minimal pain and trace swelling, they will not need to be seen in PT again for 4 weeks.

Week 18

Review program. Increase intensity as appropriate. Instruct in advanced functional/agility: sprinting, cutting and sports specific drills as tolerated.

Proprioceptive work may include hopping and jumping activities with emphasis on good landing technique.

Pool workouts can include use of flippers for flutter kicks.

Week 24

24 Week Functional Tests:

One-legged hop for distance:
Patient performs one-legged hop, which consist of recording the distance a patient travels in one hop on a single leg. Each patient is allowed one trial for each leg, then performs two hops per leg for maximum measurement.

Timed one-legged hop:
A measured distance of twenty feet is marked out, at the word "go", the patient begins a series of one legged hops from start line to finish line. The patient is timed from the start line to the finish line.
Each patient is allowed to complete a slow trial and then two tests are completed on the uninvolved leg and two on the involved leg.

One legged squat for depth:
Patient is tested in their ability to perform a one legged mini-squat to touch floor with opposite hand with moderate trunk flexion.

Stage V

5 – 6 Months

Return to Sport

Can safely do open kinetic chain quadriceps work (ie: leg extensions)

Continue to progress plyometrics and sport drills.

Return to training and participate in skill exercises.

Continue to improve power and endurance

Advice may be needed as for the modifications to be able to return to sport.