Intermediate Knee Overuse Rehabilitation

Joint effusion reduced to minimal swelling,Pain at rest less than 3/10 on VAS scale,Full extension achieved equal to contralateral knee,Quadriceps activation with visible quadriceps contraction,Patellar mobility restored (medial-lateral glide),MCL/LCL tenderness significantly reduced

→ Advance to: Early Mobility Phase

Passive knee flexion to 90 degrees achieved,Active knee extension within 5 degrees of full extension,Weight bearing as tolerated with assistive device,No increased warmth over ACL/PCL graft site,Hamstrings able to contract without increased pain,Meniscus symptoms not exacerbated with movement

→ Advance to: Early Mobility Phase

Passive knee flexion to 110 degrees,Active knee flexion to 90 degrees,Full weight bearing without assistive device,Quadriceps strength 4/5 on manual muscle testing,No pivot shift present with Lachman test,Patellar tracking normalized without crepitus

→ Advance to: Early Strengthening Phase

Passive knee flexion to 120 degrees,Active knee flexion to 105 degrees,Normal gait pattern without compensation,Quadriceps strength 4+/5 on MMT,Cartilage loading tolerance improved,No mechanical symptoms with knee flexion

→ Advance to: Early Strengthening Phase

Full passive knee flexion achieved,Active knee flexion to 120 degrees,Quadriceps strength 4+/5 bilateral,Hamstrings strength 4/5 on MMT,Single leg stance 30 seconds without instability,Patellofemoral symptoms not provoked with loading

→ Advance to: Progressive Strengthening Phase

Full range of motion achieved,Quadriceps strength 5-/5 on MMT,Hamstrings strength 4+/5 on MMT,Single leg squat to 45 degrees knee flexion,No giving way with weight bearing activities,MCL/LCL stability confirmed with valgus/varus stress

→ Advance to: Progressive Strengthening Phase

Quadriceps strength 5/5 on MMT,Hamstrings strength 5-/5 on MMT,Single leg squat to 60 degrees knee flexion,Step-up test without compensation,Calf raise bilateral equal,Patella tendon loading tolerance established

→ Advance to: Progressive Strengthening Phase

Single leg squat to 75 degrees knee flexion,Step-down test without valgus collapse,Hamstrings curl resistance increased,Quadriceps loading at 50% body weight,No pain with ACL/PCL loading activities,Meniscus loading test negative

→ Advance to: Advanced Strengthening Phase

Single leg hop for distance 75% contralateral,Isokinetic quadriceps at 60 deg/sec >70% contralateral,Isokinetic hamstrings at 60 deg/sec >80% contralateral,Squat depth to parallel,No effusion with exercise progression,Patellofemoral joint compression tolerance improved

→ Advance to: Advanced Strengthening Phase

Single leg hop for distance 85% contralateral,Single leg vertical hop test >80% contralateral,Triple hop test >80% contralateral,Agility testing without instability,No increased laxity on KT-1000 testing,Cartilage loading progression tolerated

→ Advance to: Advanced Strengthening Phase

Single leg hop for distance 90% contralateral,Side hop test >90% contralateral,Figure-8 hop test >85% contralateral,Cutting maneuvers without giving way,Plyometric progression initiated,Patellar tendon load progression tolerated

→ Advance to: Return to Activity Phase

All single leg hop tests >90% contralateral,Agility shuttle run completed without symptoms,Plyometric double leg jumps initiated,Isokinetic quadriceps at 300 deg/sec >85% contralateral,No subjective instability reported,MCL/LCL stress test negative

→ Advance to: Return to Activity Phase

Single leg hop for distance 100% contralateral,Running program initiated at 50% effort,Cutting drills at 50% speed,Squat strength >1.5x body weight,No recurrence of effusion with activity,Patellofemoral symptoms absent with loading

→ Advance to: Return to Activity Phase

Running at 75% maximum speed,Cutting and pivoting at 75% speed,Sport-specific drills initiated,Functional movement pattern normalized,No pain with ACL/PCL loading maneuvers,Meniscus stress test negative

→ Advance to: Return to Sport Phase

Running at full speed without symptoms,Cutting drills at full speed,Non-contact sport-specific drills completed,Isokinetic quadriceps at 300 deg/sec >95% contralateral,Subjective knee function score >90 on IKDC,Patella loading at full capacity without symptoms

→ Advance to: Return to Sport Phase

Full practice participation cleared,Contact drills initiated,Single leg hop battery 100% contralateral,No giving way with sport-specific movements,Quadriceps symmetry index >95%,Hamstrings symmetry index >95%

→ Advance to: Return to Sport Phase

Full scrimmage participation,No bracing required during sport,Return to sport test battery passed,Psychological readiness confirmed,No cartilage symptoms with impact activities,MCL/LCL stability maintained

→ Advance to: Return to Sport Phase

Full return to competitive sport,IKDC subjective score >95,Tegner activity scale at pre-injury level,Lysholm score >95,No restrictions on knee loading,Maintenance program established

→ Advance to: Completion