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Knee Dislocation Reconstruction - Physical Therapy Protocol

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Preoperative Guidelines

  • Restore full AROM
  • Teach normal heel-toe gait
  • Strengthen involved extremity
  • Decrease effusion
  • Educate Patient on post-op protocol, use of crutches (level and stairs), importance of extension


Note: Exercise prescription is dependent upon the tissue healing process and individual functional readiness in all stages. If any concerns or complications arise regarding the progress of any patient, physical therapy will contact the orthopedist.


Phase I (Post-op Days 1 – 14)

  • No Stationary Bike
  • Brace – locked at 0 for ambulation
    • unlock to available range when pt has good quad control: SLR x 30
    • without lag NOT to exceed 70 degrees
  • Crutches – touch WB in brace (D/C crutches at 6 weeks if gait is WNL)
  • Patellar mobilization (teach patient)
  • Calf pumping
  • Passive extension with heel on bolster or prone hangs
  • AAROM 0-70 degrees
  • Electrical stimulation in full extension with quad sets and SLR
  • SLR x 4 in brace (parallel bars if poor quad control)
  • Ice pack with knee in full extension after exercise


Goals: Full passive extension, Good quad control: SLR x 30 without lag


Phase II (Weeks 3 – 4)

  • No Stationary Bike
  • Brace – open to available range – Not to exceed 70 degrees
  • Crutches – PWB
  • Continue appropriate previous exercises
  • Scar massage when incision healed
  • PROM, AAROM, AROM 0-90 degrees
  • SLR x 3 (No hip ADD) on mat – no resistance
  • Total Gym – progress levels of mini-squats as tolerated (not >45 deg)
    • passive flexion to 90 degrees (push up with opposite leg)
  • Weight shifts – supported in parallel bars
  • Stretches – HS, AT, Hip Flexors, ITB


Goals: ROM 0-90 degrees, no effusion


PHASE III (Weeks 4 – 6)

  • Brace – open to available range
  • Crutches – PWB
  • Continue appropriate previous exercises
  • PROM, AAROM, AROM 0-110 degrees
  • Mini squats, weight shifts – in parallel bars
  • Standing SLR x 4 w/Theraband in brace
  • Hamstring curls – closed chain (carpet drags or rolling stool)
  • Leg press with resistance no more than ½ body weight
  • Double leg heel raises
  • Stationary bike – ROM as tolerated (minimal resistance)
  • Pool therapy – walking and jogging (no kicking)


Goals: ROM 0-110 degrees, Normal gait in parallel bars


PHASE IV (Weeks 6 – 10)

  • D/C brace
  • Crutches – WBAT (D/C when gait is WNL)
  • Continue appropriate previous exercises
  • Partial wall squats – No knee flexion past 45 degrees
  • Forward, lateral, and retro step downs in parallel bars
    • No knee flexion past 45 degrees
  • Single leg heel raises
  • Proprioceptive training – Single leg standing in parallel bars
    • Double leg BAPS for weight shift
    • Progress to single leg BAPS, Ball Toss, and Body Blade
  • Standing SLR x 4 with Theraband bilaterally
  • Stationary bike for progressive resistance and time
  • Elliptical trainer
  • Treadmill – Backwards and forwards walking


Goals: Full ROM, Normal gait


PHASE V (Weeks 10 – 12)

  • Continue appropriate previous exercises
  • Hamstring curls – with resistance no more than ¼ body weight
  • Leg Press – progress weight as tolerated
  • Functional activities – Fitter, slide board, figure 8s, gentle loops, large zigzags
  • Treadmill – Walking progression program
  • Pool therapy – unrestricted


Goal: Walk 2 miles at 15 min/mile pace


PHASE VI (Months 3 – 4)

  • No squatting >90 degrees
  • Continue appropriate previous exercises with progressive resistance
  • Leg press – single leg
  • May begin incorporating open chain knee extension exercises as tolerated
  • Treadmill – Jogging program
  • Pool – Begin swimming laps


Goal: Jog 2 miles at easy pace


PHASE VII (Months 4 – 6)

  • Home/gym program
  • Continue strengthening, stretching, and proprioceptive training programs
  • Agility drills / Plyometrics
  • Quad stretches
  • Sit-up progression
  • Treadmill – Running progression program
  • Functional test at 6 months to clear for sports and discharge
    • Must have 90% of opposite leg


Goal: Run 2 miles at normal pace

PHASE VIII (Months 6 – 9)

  • Continue appropriate previous exercises with progressive resistance
  • Treadmill or Track – Running progression program


Goals: Return to all activities


No contact sports until 9 months post-op

 

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