Wound-healing phase and/or time post surgery | Therapy goal | Classic | Stop-X |
---|---|---|---|
Inflammation phase | Reduction of inflammation | Brace: range of motion restriction 0–0-90° at 20-kg partial knee load | |
Manual therapeutic, passive closed kinematic chain mobilization; hip and ankle integrated | |||
Measures against post-operative swelling and temperature increase, home-based measures for auto-mobilization (under compression) | |||
Trunk and scapula control; non-affected-side static motor control, i.e., single-leg stance | |||
Proliferation phase Approximately weeks 3–12 post reconstruction | Knee-joint mobilization in restricted range of movement, patellar mobilization | ||
Stretching: Mm. ischiocruales, M. gastrocnemius, M. iliopsoas, M. tractusiliotibialis | |||
Motor control of trunk and scapula; non-affected-side static motor control, i.e., single-leg stance | |||
Approximately after week 7 post reconstruction | Brace: range of motion unrestricted | ||
Onset of motor-control training | |||
Open kinetic (dorsal only) chain | |||
Approximately after week 10 post reconstruction | Corrective exercise with the aim to prepare for return to sport (RTS) level I | ||
Single-leg dynamic-stabilizing/motor-control exercises | |||
Eccentric knee mobilization open frontal kinetic chain | |||
Remodeling phase Level I function: Approximately after week 13 post reconstruction | Functional enhancement and recurrence prevention | Closed and open kinetic chain (ventral and dorsal) | Based on functional criteria, not time based. Information, risk assessment, correction of risky movement characteristics; teaching of basic preventive strategies; total program at/after RTS clearance Running exercises/agility exercises Straight on running, hip external rotation, change of direction runs Running with sagittal plane distance and vertical-jump components. Self-perturbed balance exercises Single-leg stance with (individually and combined) ball bouncing/unstable surface/passing a ball Jumping exercises/plyometrics vertical and distance Strengthening exercises Russian hamstrings Dynamic and side planks with/without heel raising Hip abduction One-legged squats |
Strength endurance training for (in particular) the ischiocrural muscles | |||
Dynamic-stabilizing motor-control exercises, including jump landings on unstable surfaces | |||
Level II function: Approximately months 4–6 post reconstruction | Dynamic-stabilizing motor-control exercises, including single (affected) leg jump landings on unstable surfaces | ||
Onset of impact exercises | |||
Level III function: Approximately after month 7 post reconstruction | Dynamic exercises (frontal plane) | ||
Side-cutting maneuvers | |||
Level IV function: Not before 10th month post reconstruction | Dynamic multi-directional stabilization |