Lakhasly

Table 1.KT 1000 knee ligament arthrometer exam, isokinetic test, hop test(s), quality movement assessment at 6 months ?Acceptable quality movement assessment Precautions: ?Acceptable quality movement assessment ?Anterior cruciate ligament (BTB) rehabilitation guideline Post-operative phase I (weeks 0-2) Goals: ?Emphasize patient compliance to home therapeutic exercise program and weight bearing precautions/progression Criteria for advancement: ?Progressive weight bearing/WBAT (patella tendon) with crutches brace opened 0?Brace changed to MD preference (OTS brace, patella sleeve, etc.) ?Functional progression pending KT1000 and functional assessment Post-operative phase 4 (weeks 14-22) Goals: ?Avoid descending stairs reciprocally until adequate quadriceps control and lower extremity alignment ?Lack of apprehension with plyometric and agility activities to date Post-operative phase 5--return to sport (weeks 22-?) Goals: ?PWB -> WBAT (patella tendon) with brace locked at 0?Demonstrate ability to unilateral (involved extremity) weight bear without pain Post-operative phase 2 (weeks 2-6) Goals: ?Proprioception training: prop board/balance system/contralateral Theraband exercises ?Reassess patient's complaint's (i.e., pain/swelling daily--adjust program accordingly) ?Towel extensions, prone hangs, etc.Quadriceps re-education (quad sets with EMS or EMG) ?Active flexion/active-assisted extension 90?Upper extremity cardiovascular exercises as tolerated ?Avoid pain with therapeutic exercise and functional activities Treatment strategies: ?-> 50?, if good quadriceps control (good quad set/ability to SLR without lag or pain) ?Aquaciser (gait training) if incision benign ?Hamstring/calf flexibility exercises ?Retrograde incline treadmill ambulation ?Home therapeutic exercise program: Individualized Criteria for advancement: ?Good patella mobility Post-operative phase 3 (weeks 6-14) Goals: ?Avoid running and sport activity till adequate strength development and MD clearance Treatment strategies: ?Home therapeutic exercise program: evaluation based Criteria for advancement: ?Maximize strength and flexibility as to meet demands of activities of daily living ?Isokinetic test >=85% limb symmetry Precautions: ?Avoid sport activity till adequate strength development and MD clearance Treatment strategies: ?Isotonic knee extension (full arc/pain and crepitus free) ?Home therapeutic exercise program: Individualized Criteria for advancement: ?Home therapeutic exercise program: Individualized Criteria for discharge: ?-> 90??-> 0????-> 0?-> 5?-> 90??-> 130??-> 0??-> 125??-> 40??

Table 1.
Anterior cruciate ligament (BTB) rehabilitation guideline
Post-operative phase I (weeks 0–2)
 Goals:
  ▪ Emphasis on full passive extension
  ▪ Control post-operative pain/swelling
  ▪ Range of motion 0° → 90°
  ▪ Early progressive weight bearing
  ▪ Prevent quadriceps inhibition
  ▪ Independence in home therapeutic exercise program
 Precautions:
  ▪ Avoid active knee extension 40° → 0°
  ▪ Avoid ambulation without brace locked at 0°
  ▪ Avoid heat application
  ▪ Avoid prolonged standing/walking
 Treatment strategies:
  ▪ Towel extensions, prone hangs, etc.
  ▪ Quadriceps re-education (quad sets with EMS or EMG)
  ▪ Progressive weight bearing
  ▪ PWB → WBAT (patella tendon) with brace locked at 0° with crutches
  ▪ Patella mobilization
  ▪ Active flexion/active-assisted extension 90° → 0° exercise
  ▪ SLR’s (all planes)
  ▪ Brace locked at 0° for SLR (supine)
  ▪ Short crank ergometry
  ▪ Hip progressive resisted exercises
  ▪ Proprioception board/balance system (bilateral weight bearing)
  ▪ Leg press (bilateral/80° → 5° arc) (if ROM >90°)
  ▪ Upper extremity cardiovascular exercises as tolerated
  ▪ Cryotherapy
  ▪ Home therapeutic exercise program: evaluation based
  ▪ Emphasize patient compliance to home therapeutic exercise program and weight bearing precautions/progression
 Criteria for advancement:
  ▪ Ability to SLR without quadricep lag
  ▪ ROM 0° → 90°
  ▪ Demonstrate ability to unilateral (involved extremity) weight bear without pain
Post-operative phase 2 (weeks 2–6)
 Goals:
  ▪ ROM 0° → 130°
  ▪ Good patella mobility
  ▪ Minimal swelling
  ▪ Restore normal gait (non-antalgic)
  ▪ Ascend 8″ stairs with good control without pain
 Precautions:
  ▪ Avoid descending stairs reciprocally until adequate quadriceps control and lower extremity alignment
  ▪ Avoid pain with therapeutic exercise and functional activities
 Treatment strategies:
  ▪ Progressive weight bearing/WBAT (patella tendon) with crutches brace opened 0° → 50°, if good quadriceps control (good quad set/ability to SLR without lag or pain)
  ▪ D/C crutches when gait is non-antalgic
  ▪ Brace changed to MD preference (OTS brace, patella sleeve, etc.)
  ▪ Standard ergometry (if knee ROM >115°)
  ▪ Leg press (90° → 0° arc)
  ▪ AAROM exercises
  ▪ Mini squats/weight shifts
  ▪ Proprioception training: prop board/balance system/contralateral Theraband exercises
  ▪ Initiate forward step-up program
  ▪ Stairmaster
  ▪ Aquaciser (gait training) if incision benign
  ▪ SLR’s (progressive resistance)
  ▪ Hamstring/calf flexibility exercises
  ▪ Hip/hamstring PRE
  ▪ Core stabilization exercises
  ▪ Retrograde incline treadmill ambulation
  ▪ Active knee extension to 40°
  ▪ Home therapeutic exercise program: Individualized
 Criteria for advancement:
  ▪ ROM 0° → 125°
  ▪ Normal gait pattern
  ▪ Demonstrate ability to ascend 8″ step
  ▪ Good patella mobility
Post-operative phase 3 (weeks 6–14)
 Goals:
  ▪ Restore Full ROM
  ▪ Demonstrate ability to descend 8″ stairs with good leg control without pain
  ▪ Improve ADL endurance
  ▪ Improve lower extremity flexibility
  ▪ Protect patellofemoral joint
 Precautions:
  ▪ Avoid pain with therapeutic exercise and functional activities
  ▪ Avoid running and sport activity till adequate strength development and MD clearance
 Treatment strategies:
  ▪ Progress squat program
  ▪ Initiate step down program
  ▪ Leg press
  ▪ Lunges
  ▪ Isometric → isotonic knee extensions 90° → 40°
  ▪ Advanced proprioception training (perturbations)
  ▪ Agility exercises (sport cord)
  ▪ Retrograde treadmill ambulation/running
  ▪ Quadriceps stretching
  ▪ KT 1000 knee ligament arthrometer exam at 3 months
  ▪ Home therapeutic exercise program: evaluation based
 Criteria for advancement:
  ▪ ROM to WNL
  ▪ Ability to descend 8″ stairs with good leg control/alignment without pain
  ▪ Functional progression pending KT1000 and functional assessment
Post-operative phase 4 (weeks 14–22)
 Goals:
  ▪ Demonstrate ability to run pain free
  ▪ Maximize strength and flexibility as to meet demands of activities of daily living
  ▪ Isokinetic test ≥85% limb symmetry
 Precautions:
  ▪ Avoid pain with therapeutic exercise and functional activities
  ▪ Avoid sport activity till adequate strength development and MD clearance
 Treatment strategies:
  ▪ Start forward running (treadmill) program when 8″ step down satisfactory
  ▪ Continue LE strengthening and flexibility programs
  ▪ Advance agility program/sport specific
  ▪ Start plyometric program when strength base sufficient
  ▪ Isotonic knee extension (full arc/pain and crepitus free)
  ▪ Isokinetic training (fast → moderate velocities)
  ▪ Home therapeutic exercise program: Individualized
 Criteria for advancement:
  ▪ Symptom-free running
  ▪ Isokinetic test ≥85% limb symmetry
  ▪ Lack of apprehension with plyometric and agility activities to date
Post-operative phase 5—return to sport (weeks 22–?)
 Goals:
  ▪ Lack of apprehension with sport specific movements
  ▪ Maximize strength and flexibility as to meet demands of individual’s sport activity
  ▪ Isokinetic test ≥90% limb symmetry
  ▪ Hop test ≥90% limb symmetry
  ▪ Acceptable quality movement assessment
 Precautions:
  ▪ Avoid pain with therapeutic exercise and functional activities
  ▪ Avoid sport activity till adequate strength development and MD clearance
 Treatment strategies:
  ▪ Continue to advance LE strengthening, flexibility, and agility programs
  ▪ Advance plyometric program
  ▪ Brace for sport activity (MD preference)
  ▪ Monitor patient’s activity level throughout course of rehabilitation
  ▪ Reassess patient’s complaint’s (i.e., pain/swelling daily—adjust program accordingly)
  ▪ Encourage compliance to home therapeutic exercise program
  ▪ KT 1000 knee ligament arthrometer exam, isokinetic test, hop test(s), quality movement assessment at 6 months
  ▪ Home therapeutic exercise program: Individualized
 Criteria for discharge:
  ▪ Isokinetic and functional hop test(s) ≥ 90% limb symmetry
  ▪ Acceptable quality movement assessment
  ▪ Lack of apprehension with sport specific movements
  ▪ Flexibility to accepted levels of sport performance
  ▪ Independence with gym program for maintenance and progression of therapeutic exercise program at discharge