Lateral Ligament Reconstruction-Post operative Physiotherapy protocol

Physiotherapy is extremely important in recovery and follows the below rehabilation protocol


                                 Phase 1: Recovery (0-2 weeks)
 General  :                                                          :
- Plaster backslab or CamBoot
- Non weight bearing

Goals:
- Prevent complications eg: DVT,
- Maintain movement and strength in unaffected joints

Exercises
- Hip and knee range of motion exercises
- Quadriceps, hamstrings and gluteal strengthening
- Deep breathing exercises

                                                       2-4 Weeks
General
- Transfer to camwalker boot or ankle brace (ASO or equivalent)
- Commence weight bearing, PWB or WBAT depending on surgeon’s instructions

Goals:
  Control pain
- Control swelling
- Regain active movements

Exercises:
- Free active plantarflexion, dorsiflexion, eversion
- NO active inversion until 6 weeks post op.
- Towel stretch into dorsiflexion (gentle)
- Swimming (no kicking), when wound healing appropriate

                                                    4-6 Weeks

General
- Weight bearing as comfortable (WBAT)
- Continue bracing (ASO or Boot) for majority of ‘up’ time

Goals:
- Control swelling
- Avoid impingement (in any direction)
- Avoid synovitis
- Commence strengthening

Exercises:
- Continue active ROM
- Commence PF, DF, EV Theraband strengthening
- Seated calf raises
- Static balance drills
- Swimming (no kicking)
- Exercise/Stationary bike


           Phase 2 : Strengthening/Neuromuscular training
                                                 (6 weeks +)

General:
- Normal gait
- Commence inversion movements
- Progress to general strength, proprioception, balance
- Ankle brace only for "high risk activities" or uneven surfaces

Goals:
- Minimal swelling
- +4cm lunge or better (knee to wall)
- Single leg balance 1 minute (eyes open)
- Double leg calf raises 3 x 30
- Eversion strength 4/5

Exercises:
- Theraband strengthening all directions
- Double leg calf raises, progress to single leg calf raises
- Advanced balance/proprioception, ie: wobble board, foam etc.
- Calf stretching
- Swimming with gentle kick
- Cycling as comfortable

                                                   Phase 3: Return to sport
Goals:
- Single leg balance, 1 minute, eyes open
- Single leg calf raises 3 x 30
- Single leg squat to 900
- Lunge +6cm
- Hopping on the spot
- Normal lower limb mechanics (including pelvis/hip/knee control)
- Direction change tests within 10% of other side
- Wean off brace

Exercises:
- Single leg heel raises
- Calf stretching ++
- Theraband strengthening, focus on dorsiflexion and eversion
- Hop and land
- Ladder hopping
- Lateral hopping
- Running, cycling, swimming


                                       Phase 4: Prevention of Recurrence
Goals:
- Normal mechanics
- High level balance
- Landing strategies
- Direction change strategies

Exercises:
- Advanced landing drills, +/- external factors ie: catching/marking
- "Feedforward" training
- Advanced balance integration ie: strength work on BOSU ball
- Plyometric training