Nathan WM. Skelley, M.D.

Phase I (Surgery to 2 weeks postoperative)

Appointments

• Rehabilitation appointments begin 3-5 days after surgery

Rehabilitation Goals

• Protect the post-surgical repair

Precautions

• Ambulate with crutches

• Continually use the dial brace locked in extension and crutches

  for weight bearing as tolerated (WBAT). The brace must be worn and locked at all times other than when performing rehabilitation exercises

• Follow range of motion guidelines

• Keep the incision and surfaces dry

Suggested Therapeutic Exercise

• Ankle pumps, isometric quadriceps sets, hamstring sets, glut sets and patellar mobilizations

Cardiovascular exercise

• Upper body circuit training or upper body ergometer (UBE)

Progression Criteria

• Progress two weeks post-operatively

 

Phase II (begin after meeting phase I criteria, usually 2-6 weeks)

Appointments

• Rehabilitation appointments are 1-2 times per week

Rehabilitation Goals

• Normalize gait with WBAT with gradual progression, continuing to use the brace locked in extension, the ability to discontinue the crutches will be determined by the rehabilitation provider and physician based on your progress and leg control.

• Protection of post-surgical repair

Precautions and Range of Motion (ROM)

• Continually use the dial brace locked in extension and use crutches for WBAT and ambulation. The brace must be worn and locked at all times other than when performing rehabilitation exercises.

• Weeks 3-6: 0-90 degrees of motion without active quadriceps extension

• Alterations may be made by the surgeon based on the integrity of the repair and associated injury

Suggested Therapeutic Exercise

• Heel slides

• Passive knee extension with heel resting on towel

• SLR 4 directions with brace locked in extension

• Gentle patellar mobilization

• Weight shifts with brace locked in extension

Cardiovascular exercise

• Upper body circuit training or UBE

Progression Criteria

• Progress 6 weeks post-operatively

• Knee ROM 0-0-90 degrees (avoid hyperextension)

 

Phase III (6-12 weeks post-operatively)

Appointments

• Rehabilitation appointments are once every 1-2 weeks

Rehabilitation Goals

• Normalize gait on level surfaces using brace opened to 30-40 degrees without crutches

• Initiate active quadriceps contractions in weight bearing

Precautions

• Graduate progression to weight bearing with knee flexion and avoidance of weight bearing knee flexion past 70 degrees for 12 weeks post-operatively

• Continue to follow ROM limits

Suggested Therapeutic exercises

• AROM for open chain knee flexion and extension

• Closed chain quadriceps control from 0-40 degrees with light

  squats and leg press progressing to shallow lunge steps

• Prone knee flexion

• Stationary bike

• Patellar mobilizations

• Open chain hip strengthening

• Core strengthening

Cardiovascular exercise

• Upper body circuit training or UBE

Progression criteria

• Normal gait mechanics without crutches

• Active knee ROM at least 0-0-110 degrees

 

Phase IV (12 weeks post-operative)

Appointments

• Rehabilitation appointments are once every week

Rehabilitation Goals

• Normalize gait on all surfaces without brace

• Single leg stand with good control for 10 second

• Full knee ROM

• Good control with squat to 70 degrees of flexion

Precautions

• Avoid any forceful eccentric contractions

• Avoid impact activities

• Avoid exercises that create movement compensations

Suggested Therapeutic exercises

• Non-impact balance and proprioceptive drills

• Stationary bike

• Gait drills

• Hip and core strengthening

• Stretching

Cardiovascular exercise

• Replicate sport/work

Return to sport/work criteria

• Dynamic neuromuscular control with multi-plane activities, without pain, instability or swelling

• Physician and rehabilitation specialist approval

 

Phase V (4-6 months post-operative)

Appointments

• Rehabilitation appointments are once every 1-3 weeks

Rehabilitation Goals

• Good control and no pain with sport and work specific movements

Precautions

• Post activity soreness should resolve within 24 hours

• Avoid post activity swelling

• Avoid activities causing limps

Suggested Therapeutic exercises

• Impact control exercises with progression

• Movement control exercise beginning with low velocity, single

  plane activities and progressing to higher velocity, multi-plane

  activates

• Sport/work specific balance and proprioceptive drills

• Hip and core strengthening

• Stretching for patient specific muscle imbalances

Cardiovascular exercise

• Replicate sport/work specific activities

Return to work criteria

• Dynamic neuromuscular control with multi-plane activities, without pain or swelling

Progression criteria

• Patient may return to sport after receiving clearance from the orthopedic surgeon and the PT/ATC