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0-1   week

• Gauze and dressing removed in PT; replace ace or use Jobst stocking
• Modalities including electrical stimulation for 20 minutes, biofeedback, and cryoboot
• Cyotherapy with ice, polar care, or cryocuff
• Patellar glides/mobilization
• WBAT with brace locked in extension and crutches
• May unlock brace for passive ROM
• Closed chain ROM
• Goal 0-90 degrees
• Straight leg raises in all 4 planes progressing with ankle weights
• Work on isolated control of quad if no extensor lag with SLR
• Prone extension stretch; goal extension symmetric to opposite side
• Start stationary bike; half revolutions forward and backward with progression to full revolutions
• Can start light exercises such as mini-dips, wall sits, step-ups, toe raises, 4 way tubing, stork stands, etc
• Start treadmill for gait training if good control of quads without crutches

Week 1-2

• Suture removal and wound check; continue ace wrap for residual swelling; may shower
• Open brace as flexion allows; extension should be full; should be WBAT
• Continue previous weeks exercises, bicycling, and treadmill (forward and backward)
• Add Total Gym, hamstring curls, leg press, lunges (knee not to pass foot), stool walk, stork stands, stairmaster, elliptical machine, row machine, TKE (closed chain)
• Home exercises: SLR’s, calf pumps, 4-way tubing, calf and hamstring stretches, cryotherapy

Week 2-3

• May discontinue wrap if swelling allows
• Brace open during gait 0-120 degrees if quad control allows
• Continue exercises in previous weeks, including home exercises
• Begin squats, hack squats, versa climber, resisted walking, slide board, total gym hops (low level)
• Modalities continued: electrical stimulation, cryoboot, standing TKE’s with theraband behind knee

Week 3-4

• Assess possibility of removing brace; ROM at least 0-120 degrees
• Continue exercises in previous weeks, including home exercises
• Forward and backward walking with change in direction
• Start shuffles, Carioca, and double leg hops
• More intense proprioceptive training
• Modalities stopped if appropriate

Week 4-6

• Discontinue brace and push for full ROM
• Continue exercises in previous weeks with increased intensity, including home exercises
• Add jump rope, single leg hopping, and resisted lunges
• Increase speed of exercises safely

Week 6-16

• Patient to be fitted for functional brace and worn during physical activity
• Strength 60% of opposite limb
• Patient discharged from therapy and released to home program
• Begin jogging between 9 and 12 weeks depending on doctor’s discretion
• Continue jumping rope and using ice after each workout

Week 16-20

• Continue brace
• Workouts three times per week
• Begin to perform lazy Z’s gradually picking up pace
• Jump stops should be about 50-70% of maximum speed at 5 months
• Continue to jog, begin sprinting, and continue strengthening program

Week 20-24

• Continue brace
• Functional testing to be completed including one-leg hop for time, one-leg hop for distance, and 4 corner speed drill
• Should continue working out while regaining full speed
• Return to full activity, work, or sport

Criteria for return to sport activities

• One-leg hop 90% of opposite leg
• Jog without limp
• Full-speed without a limp
• Shuttle run without a limp
• Figure 8 running without a limp
• Single leg vertical jump 90% of opposite limb
• Squat and rise from squat