Phase I – Maximum Protection (Weeks 0 to 4):
Weeks 0 to 2:
- Use crutches for 7 to 10 days to reduce swelling, the patient may discontinue with crutches when they can ambulate without a limp
- Brace locked in full extension for 4 to 6 weeks per physician orders
- Patella mobility
- Begin passive/active knee range of motion to 90° of knee flexion and strong emphasis on full knee extension
- Quadriceps setting focusing on VMO contraction
- Multi-plane open kinetic chain straight leg raising
- Gait training
- Non-weight-bearing
Weeks 2 to 4:
- Open and closed kinetic chain resisted cord multi-plane hip strengthening
- Proprioception training
- Pool program when incision sites healed; maintain 90˚ flexion limitation
- Non-weight-bearing
Phase II – Progressive Stretching and Early Strengthening (Week 4 to 6):
Weeks 4 to 6:
- Gradually restore full range of motion with emphasis on extension/hyperextension
- Normalize gait
- Open brace to 0° to 90° per physician’s orders
- Initiate lower extremity stretching program
- Stationary bike, treadmill, and/or elliptical trainer
- Closed kinetic chain strengthening progressing from bilateral to unilateral as tolerated
- Non-weight-bearing
Phase III – Advanced Strengthening and Proprioception Phase (Weeks 6 to 12):
Weeks 6 to 10:
- Wean out of brace weeks 6 to 8
Weeks 10 to 12:
- Gym-strengthening program – Progressing form bilateral to unilateral
- Leg press, squats, lunges, hamstring curls, ab/adduction, calf raises, and leg extensions (0° to 30°)
Phase IV – Strengthening and Plyometric Phase (Weeks 12 to 20):
Weeks 12 to 20:
- Implement a full gym-strengthening program
- Pool running progressing to dry land at 16 weeks as tolerated
- Advance proprioception drills
- Low impact pyometric drills at 16-20 weeks
- Fit functional brace
Phase V – Return to Sport Functional Program (Week 20 to 24):
Weeks 20-24:
- Sprinting
- Field and agility drills with brace on
Week 24–32
- Follow-up examination with physician
- Sports test for return to play
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