Day 2 -14 Ambulation Patient non weight bearing as with Knee brace (by day 14 patient should

be FWB with Knee brace. To use an elbow crutch for support. Knee Brace must be worn at night until full extension is obtained.

Minimize walking to decrease swelling.

Maintain the knee in an elevated position (above the heart) by using the

pillows until the swelling has reduced. Knee splint may be removed for exercise, bathing, sitting, and resting.

The crepe bandage on the knee to reduce the pain and swelling in the

front of the tibia use of ice packs to take care of pain

Exercises and Activities

Passive knee extensions ( with ice) and heel on block

Gastronemius stretch with towel Quadriceps - static sets with patient long sitting and towel under heel.

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Electrical muscle stimulation with knee fully extended in long sitting with towel under heel.

If you are not able to generate a muscle contraction

Isometrics - multi range 90-60* (not beyond 60*) use opposite leg. Quad set , standing against wall, pushing back extended knee into rolled towel, progress to straight leg raising to 30* in standing.

Wall slide to increase flexion, ice on knee

Sitting Supported Knee Bends

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While sitting at bedside or in a chair with your thigh supported, place your foot behind the heel of your operated knee for support. Slowly bend your knee as far as you can. Hold your knee in this position for 5 to 10 seconds. Repeat several times until your leg feels fatigued or until you can completely bend your knee.
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Passive flexion over edge of bed

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Patellar mobilizations if needed

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Hip adductors/abductors strengthening as tolerated

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Hamstrings
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Heel raises
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Goals Obtain full extension / hyperextension

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Minimize swelling
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Allow wound healing

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Maintain active quads control

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Achieve 90* of flexion (knee bending )

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Week 2-6 Ambulation Patient full weight bearing with Knee brace .Splint may discontinued at

home, but still should be used outside if slippery conditions. Use the functional ACL sport brace or (knee brace provided when u got

dicharge from the hospital) till 6 weeks

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The ACL functional brace. Exercises and Activities

Quadriceps exercises - straight leg raising in supine ( only if no quads lag) Double leg - progress to single leg squat ( not more than 45 * Knee flexion) Hamstrings - If lack of full extension, start prone hangs with weights DO IT ONLY IF YOU CANNOT STRAIGHTEN YOUR LEG FULLY

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. Step up /step down - start with 4" block and progress to 6" block

Stair climber - progress slowly start with climbing 4 steps up and 4 steps down

Stair climb from front and from the side

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Stationary bike - to increase range of motion. This is one of the safest exercises in rehab, if the knee is not allowed to go into the last 30*.

Swimming - if incisions are healed - begin with forward and backward walking in water - use buoy between knees to swim or use dolphin kick Progress proprioception from bilateral to single leg wobble board, no rotation Hip rotators with thera-band ( don't do if collateral ligament repair )

Goals Increase flexion to 135*

Decrease swelling

Increase muscle tone

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Week 6-9 Ambulation Full weight bearing - discontinue the splint

Continue the functional brace when active

Exercises and Activities

Swimming - add flutter kick at pool side or flutter board, progress to front crawl/back crawl if comfort permits Easy jogging in waist deep water

Cycle outdoors - no toe clips or standing. On level terrain

Power walking

Hamstring reconstruction may start hamstring resisted exercises

Goals Progress to full range of motion

Increase functional activities

Weeks 9-12 Ambulation Full weight bearing

Exercises and Activities

Progress power walking to walk/jog on level surface

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Lunges

Cycling - all terrain

Phantom chair - begin at 45* and progress to 90*

Skipping - both legs

Goals Increase functional activities and endurance

Weeks 12+ Ambulation Full Weight Bearing

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Exercises and Activities

Straight ahead running at 1/2 speed on level terrain

Running upstairs/walking down

Introduce interval training on bike

Proprioception and strength

Hopping drills (2 legs) progress to one leg - work all directions, gradually increasing height and/or distance of hops Add plyometric exercises - hopping down from stairs/boxes

Goals Full range of motion

Increase function, strength, and endurance

Week 14+ Exercises and Activities

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Light sport activities ( x-county skiing, curling, golf, ice skating)

Only if:

No effusion Full range of motion 75% quad/ham strength ratio ( 85% for rollerblading) Negative Lachman M.D. approval

Months 6+ Exercises and Activities

Vigorous pivoting activities if:

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90% quad/ham strength ratio as tested on the orthotron Wear functional brace for first year post op

Lateral and Torsional Work

Start figure 8's - start with large lazy 8's and decrease in size and increasing speed ( start with 50m then 30m then 10m) ( repeat 10 times each).

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Carioca - running sideways cross left foot in front of and behind right foot for 10 m and reverse pattern and direction ( repeat 5-10 times in each direction). Directional run - facing the same direction, run forward, sideways, backwards, and sideways, 10m in a square ( repeat 5-10 times in each direction). Run-cut 90* running half speed, go 20m and make 90* cut to the right and repeat to the left ( repeat 10-20 times in each direction). Return to Sport When:

Full range of motion Stable - negative Lachman and pivot shift No effusion Equal strength compared to opposite side

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