ACL PATELLAR TENDON AUTOGRAFT RECONSTRUCTION PROTOCOL WITH INTEGRATED SKILL  REHAB

 

EXAMPLE OF THE TWO WORKING TOGETHER

 

*Physician may modify time frames for the use of brace and crutches

The athlete will sleep in TROM brace locked in extension for the first week or as directed by PT/MD

 

Immediately post-op to week 4

            WBAT with brace locked in extension and crutches *

Goals:

Protect graft (neovascularization, 8 weeks) and fixation (strength and stiffness/bone plug fixation graft in proximal tibia v. distal femur (gold standard), 6 weeks)

Decreased effects of immobilization

Control inflammation/swelling – 15 minutes of compression, ice and towel under ankle for extension, before tx and after tx

Patient education – Discuss importance of working on knee extension at home

Normalize gait on level surfaces (basketball court)

 

PT EXERCISES (APPROX. WEEK 1)

Patellar/scar mobilization

Passive extension of knee with rolled towel raising calf off of the table, AAROM extension

Heel slides

Quadricep isometrics (NMES)

SLR (to 45-60 degree for 6 seconds) until there is no extension lag

HS, gastroc/soleus stretch

Gastroc/soleus strengthening

Normalize gait on basketball court as TROM brace is unlocked with the ROM present

 

PHASE ONE: INTEGRATED SKILL REHAB

Goals:

Program movement patterns

A Bosu ball will work core muscles

Mirrors and videos

 

Activities:

BACKSPIN/ LEVEL OF ARC/HAND-EYE COORDINATION

Make sure ball is appropriate size for player

Without the player sitting on Bosu ball

            Program hands movement without the ball and make sure non-shooting hand stays up (MIRROR/VIDEO)

            Create a quarter turn from the waist up to forehead or above eyes

            Create the mindset that 21 times in a row equals a habit

With the player sitting on Bosu ball

            Progress to using the ball – program backspin – fingers driving through the ball

            Repeat the same movements

            Three fingers in the center of the ball

            Educate on the balance fingers

Non-shooting hand fingers

Arc Training

            Using the court, educate the player on different levels of arc and then practice

Arc-Activities

            Shoot to the hand, line drills, hit the backboard while sitting – program the “set point,’ straight lines, shooting touch, hands inside lines of the rim, timing, rhythm, and distance

           

Continuing Phase ONE (week 2)

Physician Visit

Suture removal – patient education on maintaining incision (10 days – 2 weeks)

Goals

Maintain full knee extension

If athlete demonstrates volitional quadriceps control with no knee extensor lag - d/c knee brace (possibly s/p 2 weeks)*

Control swelling

Achieve 100-120 degrees of knee flexion

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PT Exercises

Full passive extension, gravity assisted and active flexion working to 90-100 degrees of flexion, active-assisted extension, quadriceps isometrics and SLR

Stationary cycling for ROM if 100 degrees of flexion present, progress resistance as tolerated

Progress to normalizing gait on basketball court while dribbling basketball  

Hamstring curls adding weight as tolerated (with patellar tendon autograft)

CKC quadricep strengthening (wall sit, step ups, mini squats (teach appropriate mechanics with full squat in mind), 90-30 degree leg press, quad isometrics at 60 and 90 degrees) *utilizing a basketball with mini squats, wall sits

Toe raises

Single leg balance (proprioception), *without/with basketball

 

PHASE TWO: INTEGRATED SKILL REHAB

Goals

Check with PT/physician for protocol

Continued progressive 21’s

Rebuilding the shot mechanics with the ball

Balancing on one leg combined with sitting on Bosu ball

 

Activities…Shooting moving further from the ball

BACKSPIN/ LEVEL OF ARC/HAND-EYE COORDINATION

            “STEPPER SERIES”

Functional shot movements: “Stepper series” for two weeks. Combining standing for 15 shots, and sitting for 10 shots to rest the opposite leg 

Stationary (no pressure to injured area)

Shot training/Programming

Train the left hand to shoot, this process is done in an effort to program the movements in the brain and then transfer the movement to the right hand

Still programming all movement above as in phase one, but in a different drill set

15 shots from 5 spots, honing in on what has been taught from phase one

 

POST-OPERATIVE WEEK 3

Goals

Full ROM

Strengthening

PT Exercises

Stationary bike

Quad isometrics

Continue partial squats, wall sits, step-ups  (with/without basketball), Inclined leg press (70-0 degree range)

Frontal plane and sagittal plane cone drill walking speed

Toe raises

Hip SL clams with TheraBand

Monster walks with TheraBand

 

PHASE THREE: INTEGRATED SKILL REHAB

Goals

            Start introducing lower body movements (because knee brace is d/c and ROM is close to full)

Activities

            Test shooting mechanics

                        21’s with no ball

            110’s: included trying to repeat movement patterns, not just making shots. Progress to different shots: Catch and shoot, off the dribble, step-back series, two steps from the basket

 

            Within these two -three weeks, the knee flexibility will increase a little more to the point where the player will feel comfortable with the movements, at a comfortable rhythm. That rhythm, the speed, based on a scale of 1-10 should be consistently around the 4 mark.

            

CRITERIA TO ADVANCE TO PHASE II OF PT (4-6 WEEKS POST-OPERATIVE)

            Full extension/hyperextension

            SLR without extensor lag

            Minimal swelling/inflammation

            Normal gait on level surfaces (basketball court)

Goals

            Greater than or equal to 125 degrees of knee flexion

            Continue to build strength

 PT Exercises

Progress stationary bike

ROM/flexibility exercises as tolerated

Tilt board/balance board

Progress CKC strengthening to step ups at increased height, partial lunges, partial squats, leg press as tolerated

Dynamic Cone drills for balance/proprioception (sagittal plane and frontal plane)

Monster walks with TheraBand

 

PHASE FOUR: INTEGRATED SKILL REHAB

At this point, we gage how well the physical therapy is going, which will usually mean a little more bending and a little faster movement – (5) speed. If that’s the case, the player is able to increase knee bend, which means the player’s shooting range will also increase, and we can add a few more pieces to the shooting mechanics. The goal is to rebuild the player’s mechanics, the thought process and the player’s knowledge so that they can defend the mechanics.

 

PT– 6-12 WEEK’S POST-OPERATIVE

 Goals

135 degrees of flexion

Full extension

Continue strengthening

Level Treadmill (AlterG?)

 

PT Exercises

Progress strengthening - CKC strengthening to step ups at increased height, partial lunges, partial squats, leg press as tolerated

Restore normal gait w/stairclimbing (because of 135 degrees of knee flexion needed for descending stairs)

Hamstring strengthening (gentle if hamstring graft is used)

Tilt board/balance

Level treadmill

Outdoor biking on level ground

 

PHASE FIVE: INTEGRATED SKILL REHAB

Repeat all previous movements

Start paying attention to makes and misses

Include all functional movements of prior phases and see if mechanics stay the same

Should be able to increase speed; movement and rhythm wise

Activities as tolerated

210’s catch and shoot – 18 feet from basket

310’s off the dribble (respectable pace) 16 feet shots

 

PT – 12-20 WEEKS POST-OPERATIVE 

Goals

Continued strength

Introduce jogging and light running

Introduce agility drills

Determine need for ACL functional brace

 

PT Exercises

Continue strengthening exercises progressing as tolerated

Start jogging (front and backward) and light running program (progress to jogging with basketball)

Introduce cone agility exercises not for time (without and with basketball/medicine ball)

 

PHASE SIX: INTEGRATED SKILL REHAB – AS TOLERATED

410’s jab series jab and reload, jab and go, jab and cross…all into shots off the dribble

510’s includes all of the above movements; add a step back to each movement before the shot

 

Add the 3 series – This starts the process of the player slowly learning how to play defense. If the defense is 3 steps away from them when they catch the ball, they automatically shoot. Two steps away they automatically drive and shoot off the dribble, and if the defense is one step away, or quickly approaching, they attack the basket.

 

We go from programming to practice speed – 50% of current level of function      

Add practice shots; eliminates the term “quick shots” which is basically the case for lower shooting percentages on every level for the game of basketball; mainly because players never learn footwork off the dribble. No rushed shots, even if they are miss-reads, learn to use patience and get the shot off.
Progression: ADD anything that could happen in a game situation so the player can go through it at 8 speed and learn how movements are done correctly and learn patience.

 

PHYSICAL THERAPY CRITERIA TO RETURN TO SPORT (6 MONTHS)

Quadriceps strength at least 80% of contralateral leg

Hamstring strength at least 80% of contralateral leg

Full ROM

No swelling

Good stability Complete a running program

 

CRITERIA FOR RETURN TO PERFORMANCE:

Full and Half Court Activities

1. Free throw shooting

2. Triple attack/Triple threat

3. Have extra players to go (8)-speed defense

4. Drills that include passing off the dribble

5. Different ways to shoot against the clock

6. Mike Miller – 21 points in two minutes

7. Critical Thinking and Attribution Theory

8. Shooting test: 80% of shots in a straight line

9. Combo-moves, footwork, changing directions

10. Skill-specific conditioning drills

11. Play a game but go (9)-speed using the 3-Essentials

 

 

 

 

 

At Integrated Skill and Mental Rehab (ISR), our "Return To Performance" program is designed to support athletes in making a seamless and efficient transition back to peak performance following an injury. Our unique approach combines the latest in physical therapy, sports psychology, and skill development to create a comprehensive rehabilitation strategy tailored to each athlete's specific needs.

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Holistic Rehabilitation Approach Our approach recognizes that recovery from sports injuries is not just about physical healing but also about mental and skill-based recovery. We integrate three core components into our rehabilitation process:

1. Physical Rehab: Our team of physical therapists and athletic trainers work closely with athletes to restore strength, flexibility, and endurance. We use cutting-edge techniques and equipment to ensure the best physical outcomes.

2. Mental Rehab: Recognizing that injury can be a significant mental setback for athletes, our sports psychologists focus on rebuilding confidence, resilience, and focus. We employ cognitive-behavioral strategies to help athletes overcome fear of re-injury and mental blocks that often accompany their return to sport.

3. Skill Rehab: We don’t just want athletes to return to their sport; we want them to return better than before. Our skill rehab focuses on the technical aspects of sport-specific movements, ensuring that athletes not only regain their previous skill level but also enhance their performance through improved techniques and efficiency.

 

Tailored Rehab Programs Each athlete's journey through the "Return To Performance" program is unique. We start with a thorough assessment to understand the specific demands of their sport and the nature of their injury. This assessment includes:

• Biomechanical analysis

• Skill proficiency evaluations

• Psychological readiness assessments

 

Based on this comprehensive evaluation, we develop a personalized rehab plan that addresses the athlete's physical, mental, and skill-related needs.

Phase-Based Rehabilitation Our rehabilitation process is divided into phases, each designed to build upon the previous one, ensuring a safe and effective return to sport:

• Phase 1: Recovery and Reconditioning - Focuses on healing and gentle conditioning to regain mobility and reduce pain.

• Phase 2: Strength and Coordination - As the athlete’s condition improves, we introduce strength training and coordination exercises to recondition the body for athletic demands.

• Phase 3: Skill Reintegration - Sports-specific skills are reintroduced and refined, with an emphasis on technique and injury prevention strategies.

• Phase 4: Performance Enhancement - The final phase focuses on optimizing performance, including speed, agility, and sport-specific tactical skills.

 

Support Beyond Rehabilitation At ISR, our commitment to athletes extends beyond physical recovery.

 

We provide ongoing support and training options to prevent future injuries and enhance overall athletic performance. Our program includes:

• Injury prevention workshops

• Nutrition and lifestyle counseling

• Continued mental coaching

 

Return To Performance isn’t just about getting back to the game; it’s about setting a new standard for the athlete’s future in sports. We ensure that when athletes step back into the game, they are not only recovered but also reinvigorated, resilient, and ready to perform at their best.

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