ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION PROTOCOL

Transcription

1 ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION PROTOCOL THOMAS J. KOVACK, D.O. ORTHOPAEDIC SPECIALISTS OF CENTRAL OHIO 3663 Ridge Mill Drive Hilliard, Ohio August 2007

2 Anterior Cruciate Ligament Reconstruction Protocol Phase I: Weeks 2-6 Walking Phase, Motion and Protection Precautions: No active extension against resistance, no twisting, no pivoting, running or jumping. 1. Weightbearing as tolerated with use of crutches. Criteria for D/C crutches is no limping. Focus on normal gait pattern. 2. ROM Focus on restoring full extension to promote proper gait sequence. 3. Controlled balance double limb; controlled balance single limb support; controlled dynamic stability of the uninvolved leg. 4. Voluntary Quadriceps contraction/hs strengthening/flexibility. 5. Decrease effusion/swelling 15 minutes after exercise. 1. Weightshifting activities with and without upper body support. Gait training focus on heel to toe gait pattern (no limping). Treadmill 4 ways when appropriate. 2. Prone knee hangs, in supine knee unsupported with pillow under heel, Inferior/Superior patellar mobilization, heel slides/supine wall slides. 3. Bike Stork standing (level surface progressing to uneven surface) 30 seconds with eyes open/eyes closed. Balanced reach leg exercise and balance reach arm exercises on uninvolved leg using the STAR. 4. Prone HS curl, T-band HS curl, SLR (no quad lag), standing calf raises HC/HS stretch. Make sure you start and finish with the stretches. 5. Electrotherapy for muscle re-education to Quadriceps. RICE for decrease effusion. Phase II: Weeks 4-9 Balance/Dynamic Joint Stability/Strengthening Precautions: Graft protection to revascularize and heal. 1.Full pain free AROM. 2. Controlled dynamic stability of involved leg even and uneven surfaces (good Quad control). 3. Stairclimbing and descending 1-2 flights of stairs. 4. Objective improvement in proprioceptive abilities.

3 1. Treadmill (4 ways) with inline progressing with weights. 2. Balance on involved leg with oppostive leg/arm reach on level surface progressing to step. Total Gym/Shuttle Bilateral Squat, Total Gym HS curls, Swiss Ball bridging with HS curl, Forward/Sidelying single legsquat (all painfree ROM). Lunges (forward/lateral/retro), Eccentric stepping, CKC TKE s, Stool Walking unilateral calf raises. 3. Stepper (Forward/Retro), Step ups/downs (forward/lateral) 4. Quick Kicks, Baps (Standing), Single leg stance trampoline ball throwing even/uneven surfaces. Phase III: Week 8-14 Advanced Muscle Strengthening/Running Phase 1. Full squat (painfree) 2. Controlled Plyometrics even surface and trampoline 3. Increased muscle strength 5/5 4. Criteria for jogging objectively measured by variable speed, times and distance. Knee stable subjectively and objectively, painfree and no effusion. Ability to stork stand with leg straight greater than 2 minutes. Ability to stork stand with knee bent for 1 minute. Impact loading on minitramp unilateral/bilateral without pain, apprehension and/or reflex inhibition. 1. Prone knee flexion stretching, weighted wall slides, joint manipulation square jumps, forward and lateral jumping progressing toward diagnols and step, figure 8 s, S s, Z s, box jogs progress with theraband resistance, total gym plyometrics for forward/moguls, trampoline jumping with rotation 3. Single leg strides on treadmill, single leg total gym forward and lateral Phase IV: Week 15 + Agility and Endurance, Sport Specific 1. Controlled jumping 2 legs, flat, even surface; controlled bounding for distance.

4 2. Controlled single leg jumps; controlled vertical jumps; controlled cutting, full speed, controlled sport-specific activities (adjusting to quick changes in directions), acceleration/deceleration, and cutting activities. 1. Single leg jumps, trampoline/balance mat 2. Series of jumps: 2-footed jump onto 6-8 in. step. Jump off step with 2 feet, then vertical jump. 3. Agility drills, full speed (various directions) using medicine balls and theraband for resistance. 4. Speed hopping-double/single leg 5. Resistive Cord: Running/side jumping/side lunging/step up-lateral-retro References: 1. JOSPT:2001;31(111): Design and Implementation of a Neuromuscular Training Program Following Anterior Cruciate Ligament Reconstruction. 2.Tulane.edu/department/orthopedics

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