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Knee Arthroscopy Labral Repair

Knee Protocols

ACL Protocol for Bone-patellar Tendon-bone Autograft

This protocol is a guideline and timelines may vary. Progression will be based on individual assessment. Patients must be able to demonstrate exercises with proper form before moving on to the next level. In order to progress, patients must demonstrate and have the following:

  • Good quad and hip control
  • No swelling
  • No pain including patellofemoral pain

If patients experience any of these symptoms, progression of exercises should be halted and patients should return to the prior level of exercises until symptoms resolve and patients can demonstrate good lower extremity mechanics.

Week 1 (1 Treatment)
Exercises:
  1. Ankle Pumps
  2. Overpressure into Full Passive Knee Extension (Passive overpressure of 5-10 lbs. just proximal to the patella may be used and the patient is instructed to lie supine for 12-15 minutes 4 times a day for a total of 60 minutes per day with the foot propped on a towel)
  3. Self Patellar Mobilizations emphasizing superior glides
  4. Quad Sets with NMES
  5. Straight Leg Raises (when no extension lag is present) with NMES
  6. Active and Passive Knee Flexion
  7. Hamstring and Calf stretches
  8. Ball Rolls
  9. Bridges
  10. Partial and Oblique Sit-Ups
  11. Weight Shifts in medial/lateral direction and in diagonal patterns
  12. Mini Squats 0-40 degrees (utilize a more forward trunk tilt to activate hamstrings)
  13. 4 Way Hip Exercises on table
  14. Standing Hamstring Curls without weight
Goals:
  • PROM 0-90 degrees
Weeks 2-4 (4 Treatments)
Exercises:
  1. Bike
  2. Progressive Resistance with Straight Leg Raises (starting with 1 lb. and progressing 1 lb. per week)
  3. 4 Way Hip Exercises on Hip Machine
  4. Bridges with theraband around thighs
  5. Sidelying Hip Abduction with Hip ER sequence
  6. Ball Bridges
  7. Core Ball Exercises including bird dog, partial/oblique sit -ups, sidelying stability ball holds
  8. Terminal Knee Extensions
  9. Shuttle Squats and Heel Raises Bilate rally
  10. Step Ups/Step Backs on 2 and 4 inch steps
  11. Lateral Step Ups on 2 and 4 inch steps
  12. Medicine Ball Trunk Rotation
  13. Prone Plank on Elbows (1 minute holds)

The following can be introduced when patients are off crutches:

  1. Gentle Perturbation Training Bilateral Stance on even surface with eyes open
  2. Cone Step Over Drills (Forward, Backward, and Lateral Steps raising the knee to the hip and land ing with a slightly flexed knee)
  3. Bilateral Mini Squats on Foam Pad and Tilt Board to 25-30 degree s knee flexion and hold 2-3 seconds
  4. Front Lunges (with a more forward trunk tilt to unload the ACL)
  5. Lateral Lunges landing on a slightly flexed knee and holding that position for 1-2 seconds)
  6. Single Leg Stance on even surface with eyes open and closed
Goals:
  1. AROM 0-115 degrees with minimal to no joint effusion
  2. Good patellar mobility
  3. No joint line or patellofemoral pain
  4. Normal gait mechanics without crutches (D/C crutches 10-14 days post op)
    • The involved quad will demonstrate at least 60% of contralateral limb quad strength using a hand held dynamometer on the ankle with the knee flexed at 60°
Weeks 4-7 (7 Treatments)
Exercises:
  1. Step Ups/Step Backs on 6 and 8 inch steps
  2. Eccentric Lowering off Step Heights 2-8 inches
  3. Step Ups and Overs off Step Heights 2-8 inches
  4. Lateral Step Ups and Overs (right and left) off Heights 2-8 inches
  5. Hip Hikes
  6. Gentle Perturbation Training Bilateral Stance on even surface with eyes closed
  7. Lateral Stepping with resistance band around distal femur and knee flexed at 30 degrees
  8. Single Leg Bridges
  9. Bridge Holds with Alternating Knee Extension (no contralateral hip drop allowed)
  10. Shuttle Squats and Heel Raises Single Leg
  11. Star Grid
  12. Multiple Plane/Diagonal Lunges (knee Is in line with the second toe)
  13. Lateral Lunges with Rotation
  14. Single Leg Stance with non involved leg moving into abduct ion/ adduction and arms into flexion, extension, abduction/adduction, and diagonals; progress to unstable surface and weights in hands
  15. Perturbation
Goals:
  • AROM 0-125 degrees
Weeks 7-10 (7 Treatments)
Exercises:
  1. Balance on Tilt Boards Bilaterally with knee flexed at 30 degrees
  2. Perturbation Training Bilaterally on a roller board, tilt board, fitter, bosuball
  3. Lateral Lunges on Foam Pad (knee needs to demonstrate proper alignment and control with patient landing on a slightly flexed knee and able to hold for 1-2 seconds)
  4. Bilateral Balance and Board Throws with knee flexed at 30 degrees
  5. Lateral Step Downs with theraband resistance around femur to control valgus movement off 8 inch step
  6. Front Step Downs Holding Weights off 8 inch step
  7. Walking Lunges with glute squeeze on open chain leg
  8. Hip ER with knee on rolling chair and theraband on ankle
  9. Wii Balance Activities including Yoga Tree Position
  10. Prone Plank on Hands Alternating Hip/Hand
  11. Side Plank on Elbows with Hip Abducted (30-60 seconds holds)
  12. Pool Running and Agility Drills
  13. Mini Hops Bilaterally on Shuttle (with soft landing on toes and knees slightly flexed)
Goals:
  • Restore Full Knee ROM

To progress to the next phase, one must demonstrate good quad control and no genuvalgum, hip internal rotation, and adduction in a closed chain movement.

With articular cartilage lesions, compressive forces early in the rehabilitation process must be avoided. With these patients, a progressive loading program utilizing pool therapy can be beneficial.

Delay impact activities 3 months.

Weeks 10-13 (1 Treatment)
Exercises:
  1. Single Balance on half foam roll, bosuball, dynadisc
  2. Single Leg 60 Degree Knee Bends with sports cord
  3. Single Leg Stance on Foam Holding Medicine Ball (add perturbations via t he ball when patient is stable and controlled)
  4. Side Plank on Elbows with Hip Abduction/Adduction (30-60 seconds holds)
  5. Side Plank on Elbows with Hip Flexion/Extension (30-60 seconds holds)

Begin at Week 12:

  1. Jump Bilaterally x 1 (sub maximal vertical) with proper form
  2. Jump Bilaterally x 1 (maximal vertical) with proper form

The following will progress from submaximal to max effort:

  1. Jump Bilaterally x 1 (forward) and hold knee in flexed position 5-10 seconds post
  2. Jump Bilaterally x 3 (triple jump forward)
  3. Jump Bilaterally x 1 (backwards)
  4. Jump Bilaterally x 1 (side to side)
  5. Jump Bilaterally x 1 (clockwise and counterclockwise)

Proper form must be exhibited without pain and repetitions are progressed as tolerated.

Weeks 13-16 (2 Treatments Including Midterm)
Exercises:
  1. Plyometric Bilateral Leg Press
  2. Box Jumps Bilaterally (multidirectional)
  3. Lateral side steps with sports cord (right to left and left to right)
  4. Lateral Lunges on Foam Pad with resistance
  5. Jump Rope Bilaterally
  6. 2-10 Inch Drop Box Jump Progression (To progress from each step height, one must demonstrate a soft land with no genu valgum and no hip internal rotation and adduction.)
  7. Single Leg Forward Jumps Landing Bilaterally (submaximal to maximal)
Midterm Functional Knee Test Given (4 Months):
Months 4-6 (1 Treatment)
Exercises:

Patient continues strengthening exercises progressing from low to moderate to high intensity weight with functional sport specific training emphasized.

  1. Single Leg Balance on uneven surfaces with ball toss
  2. Single Leg Perturbations on uneven surfaces
  3. Lateral Lunges on Foam Pad with resistance and ball toss
  4. Shuttle Runs (alternating feet hops)
  5. Jump Rope Alternating Feet
  6. Skip Lunging
  7. High Knee Skips
  8. Butt Kicks
  9. Running
  10. Side shuffling/Cariocas 
  11. Zigzags
  12. 45 Degrees Cutting Drills
  13. Jumping Jacks
  14. Sudden Starts and Stops
  15. Vertical Single Leg Jumps land ing on involved leg x l (submaximal to maximal
  16. Single Leg Forward Hop X 1 (submaximal to maximal)
  17. Single Leg Forward Hop x 2 (submaximal to maximal)
  18. Single Leg Forward Hop x 3 (submaximal to maximal)
  19. Single Leg Forward Hop Distance (10 feet progressing to 20 feet)
  20. Single Leg Lateral Hop x 1 (submaximal to maximal landing on involved leg both directions)
  21. Single Leg Lateral Hop x 2 (submaximal to maximal land ing on involved leg both directions)
  22. Single Leg Lateral Hop Timed (10 seconds progressing to 60 seconds both directions)
Final Functional Knee Test Given @ 6 Months (1 Treatment):​
Protocol Disclaimer:

These are to simply be used as guidelines. This information is provided for informational and educational purposes only. Specific treatment of a patient should be based on individual needs and the medical care deemed necessary by the treating physician and therapists. I take no responsibility or assume no liability for improper use of these protocols. Consult your treating physician or therapist for specific courses of treatment.