中級 膝術後リハビリテーション

Quadriceps activation with VMO firing pattern ≥ 3/5 manual muscle test,Knee flexion ROM 90-110° with minimal pain,Full knee extension ROM achieved (0° neutral),Weight-bearing tolerance at 50% body weight with assistive device,Patellar mobility restored with superior/inferial glide 2/4 quadrants,No active knee swelling (trace or less on ballottement)

→ 次の段階へ： Progressive Strengthening

Quadriceps strength ≥ 3+/5 MMT,Knee flexion ROM 100-120°,Weight-bearing 75% body weight with single point cane,Hamstring isometrics at 60° knee flexion without pain,Tibiofemoral joint alignment maintained during weight-bearing,MCL/LCL stress test negative for instability

→ 次の段階へ： Strength Building

Full weight-bearing without assistive device,Quadriceps strength 4-/5 MMT,Knee flexion ROM 115-125°,Hamstring curls with light resistance (2-3 kg),Closed kinetic chain exercises at 0-45° knee flexion,Patellofemoral tracking symptomatic during loaded knee extension

→ 次の段階へ： Intermediate Strengthening

Quadriceps strength 4/5 MMT,Knee flexion ROM 120-130°,Single-leg stance balance ≥ 30 seconds eyes closed,Hamstring strength 3+/5 MMT,Cartilage loading tolerance for 15 minutes low-impact activity,PCL tibial sag reduction with posterior drawer counterforce

→ 次の段階へ： Advanced Strengthening

Quadriceps strength 4+/5 MMT,Knee flexion ROM 125-135°,Hamstring curls 5-8 kg without posterior knee pain,Open kinetic chain quadriceps 0-45° with 2-3 kg,Single-leg squat to 45° knee flexion without valgus collapse,MCL/LCL stability confirmed at 0° and 30° flexion

→ 次の段階へ： Power Development

Quadriceps peak torque 60% contralateral side at 60°/s,Knee extension ROM equal to contralateral side,Propioreceptive training on unstable surface 2 minutes,Eccentric quadriceps control through full ROM,Meniscus stress test negative for reproducible pain,Patellar tendon loading tolerance without anterior knee pain

→ 次の段階へ： Functional Training

Single-leg hop for distance ≥ 50% contralateral limb,Knee flexion 135° with symmetric quadriceps softness,Cycling 15 minutes at 80 RPM low resistance,Aquatic running program initiated,ACL graft maturation phase - progressive loading without резкое напряжение,Tibial translation < 5mm on instrumented laxity testing

→ 次の段階へ： Sport-Specific Preparation

Quadriceps strength 70% contralateral side,Single-leg vertical hop test ≥ 60% contralateral,Cutting drills at 50% speed without knee valgus,Agility ladder work at 75% effort,Patellofemoral joint compression test negative,Hamstring-to-quadriceps ratio ≥ 60%

→ 次の段階へ： Advanced Conditioning

Running progression 5 mph for 20 minutes,Figure-8 running at 75% speed,Single-leg landing from 12-inch box control,Knee proprioception 90% contralateral side on stability index,MCL/LCL functional stability during pivoting,Cartilage tolerance 30 minutes weight-bearing activity

→ 次の段階へ： Return to Activity Phase 1

Full sports-specific running without limitations,Unanticipated cutting drills 50% intensity,Quadriceps peak torque 70% contralateral at 180°/s,No recurrent knee swelling with activity,Patellar mobility full in all planes,Meniscus compression/distraction test negative

→ 次の段階へ： Return to Activity Phase 2

Cutting and pivoting at 75% intensity,Single-leg hop battery ≥ 65% contralateral,Agility testing T-test within 15% baseline,Knee flexion strength endurance 20 reps at 50% 1RM,PCL posterior tibial translation < 3mm with weight-bearing,LCL varus stress test negative at 0° and 30°

→ 次の段階へ： Return to Sport Training

Full-contact sport-specific drills 50% intensity,Knee outcome scores: IKDC subjective ≥ 70,Quadriceps strength 75% contralateral side,Landing biomechanics within normal limits,No knee effusion post-exercise,Patellofemoral arthokineic motion symmetric

→ 次の段階へ： Advanced Sport Training

Sport-specific drills at 75% intensity,Time-to-stabilization landing < 300ms,Hamstring eccentric strength 70% contralateral,Cutting at full speed with controlled deceleration,Knee stability confirmed with Lachman < 5mm translation,Cartilage loading progression to moderate impact

→ 次の段階へ： Return to Competition Prep

Full practice participation 75% duration,Knee outcome scores: KOOS sport/recreation ≥ 70,Single-leg hop for distance ≥ 75% contralateral,Quadriceps strength 80% contralateral at 60°/s,MCL functional healing at 90° flexion stress,No patellar instability symptoms

→ 次の段階へ： Competition Re-entry

Full practice participation with contact drills,Triple hop test ≥ 75% contralateral limb,IKDC objective score category A or B,No knee giving way with sport-specific movements,Patellar tendon load tolerance for jumping,Meniscus functional test negative for clicking/locking

→ 次の段階へ： Full Return to Sport

Return to competition full duration,Knee outcome scores: Lysholm ≥ 80,Quadriceps strength 85% contralateral side,All hop tests ≥ 80% contralateral,Subjective knee function rating 8/10 or better,No activity-related knee effusion

→ 次の段階へ： Maintenance

Sustained sport performance at pre-injury level,Quadriceps index ≥ 90% contralateral side,All knee ligament exams stable,Full ROM equal to contralateral knee,Patient satisfaction ≥ 8/10,No modifications needed for sport participation