Stage 1: Within 4w post-operative
Rehabilitation goals
1.Protection of the graft, brace fixation of the affected limb in addition to exercise
2.Control inflammation and edema
3.Reduce pain
4.Full extension of the knee joint
5.Flexion of the knee <90° in order to protect the fixation of the graft
6.Restore normal gait at a certain level
Rehabilitation program
1.Pressure cold therapy, Tens, NMES, CPM
2.Functional training: active assisted calf flexion within 1w; active calf flexion after 1w, delayed strength exercises to 12w; heel sliding backwards (<90 degrees); quadriceps isometric contraction; gastrocnemius/flounder muscle retraction; gentle s-string muscle retraction within 1w; SLR (various positions, with braces); quadriceps 60/90 degrees isometric contraction
3.Weight-bearing: 0~1w, PWB of the affected limb with double crutches; 1~4 weeks, PWB progression to FWB
4, Brace: 0~1w, brace locked at full extension during activity and sleep; 1~3w, brace locked at 90° when quadriceps muscle strength is insufficient; 3~4w, discard brace when patient has good control of quadriceps muscle and normal walking
Stage 2: 4w to 12w postoperatively
Criteria for assessing entry into stage II.
1, full knee extension/hyper-extension
2, good quadriceps muscle strength, no extension lag in SLR
3. Flexion of the knee to 90 degrees
4. Substantial elimination of edema and inflammation
5.Basically normal gait
Rehabilitation goals
1.Keep normal gait when climbing stairs
2.Keep the knee in full extension and increase the flexion angle as much as possible
3.Protect the graft
4.Increase the strength of the hip, quadriceps and calf
5.Increase proprioception
Rehabilitation plan
1.Functional training: continue joint mobility and flexibility training; start quadriceps closed chain exercise (half squat, micro squat, etc.); progressive gluteus, s-string, calf muscle training; continue s-string, gastrocnemius, flounder muscle tension; step training, treadmill (start weight loss running training at 10w~12w); power bike training; proprioceptive training
2, brace: 4~8w after surgery, patients use brace in injury-prone situations (e.g. crowded, unstable roads)
3.After 4w, when the patient has reestablished a normal gait and is able to raise the leg straight and without extensor lag, the crutches or brace can be discarded in walking
Stage 3: 12w to 18/20w postoperatively
Criteria for assessing entry into stage 3.
1. No pain in the patellofemoral joint
2. Knee flexion of at least 120°
3. Sufficient strength and proprioception to begin running training
4, Elimination of edema/inflammation
Rehabilitation goals
1.Full joint mobility
2.Improve muscle strength, endurance, proprioception of lower extremity
3.Avoid overloading of the graft
4.Progressive s-rope muscle resistance training
5.Protect the patellofemoral joint
6.Normal running gait
7.Isometric muscle strength assessment, the muscle strength of the affected lower limb is close to 70% of that of the healthy side
Rehabilitation plan
1.Continue mobility exercises, flexibility exercises
2.Open chain knee extension training
3.Isometric training
4.Start running exercises under full weight at 16w
5.Swimming
6.Isometric muscle strength test is recommended in 14-16w
7.Hip, quadriceps, s rope muscle, calf strength exercises
8.Endurance, proprioceptive training
Phase IV: Postoperative 4.5/5m～6/7m
Criteria for assessing entry into stage IV.
1.No serious edema, inflammation
2, full range of painless joint mobility
3, patellofemoral joint intact
4, isometric muscle strength test of the affected limb strength up to 70% of the healthy limb
5, sufficient strength and proprioception to begin agility training
6.Normal running gait
Rehabilitation goals
1.Bilateral symmetrical agility exercises for basic and sporting events
2.Single leg jump and triple jump up to 85% of the healthy side
3.Isometric muscle strength test, quadriceps and N cord muscle strength, at least 85% of the healthy side
Rehabilitation plan
1.Continue flexibility and strength exercises
2.In order to achieve the patient’s motor goals, start appropriate super-length training
3.Agility training: side walk; cross walk; figure 8 run; round trip run; single and double leg jump; acceleration/deceleration/jump; step exercise
4.Continue long-distance running according to the patient’s needs
5.Select appropriate special sports exercises for the patient