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Preoperative Guidelines
- Restore full AROM, normal gait and balance
- Strengthen involved extremity
- Educate patient on:
- Post-op exercises
- Use of crutches (level and stairs)
- Post-op precautions: importance of extension, bedpositioning, brace (locked at 0 degrees for ambulation), avoid active HS exercises 1st 6 weeks, avoid flexion > 60 degrees
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 (Days 1-7)
- Long leg brace locked at 0 degrees
- Ambulate with crutches WBAT with brace locked at 0.
- Stair education with brace locked at 0.
- Prone hangs and/or supine extension with bolster to 0 degrees ext
- If ACL is not involved: Active Ext 45-0 (do not exceed 60 degrees flex) Progress 60-0
- Passive Flex 0-60 (do not exceed 60 degrees flex). NO active HS
- Gentle HS/gastroc/soleus stretch
- Calf pumping
- Patellar mobilization
- Quad sets: use e-stim. if patient unable to perform independently
- SLR without lag (brace on). Do in parallel bars if poor quad control
- Double leg calf raises (brace on)
- Well-leg Theraband in parallel bars (brace on)
- Well-leg bicycle
- UBE
- Ice pack with knee in extension
Goals: Full passive extension, SLR without lag, ROM 0-50 degrees
Phase II (Weeks 2 - 3)
- Long leg brace locked at 0 degrees-ambulate with crutches WBAT
- Continue patellar mobilization
- Begin scar massage after incision site sloughs and scar is formed
- Ensure full extension to 0 degrees
- Continue HS/gastroc/soleus stretch
- Continue Passive Flex. 0-60 (do not exceed 60 degrees). NO active HS
- Continue short arc quads 0-60 degrees (if no RPPS symptoms)
- Double Leg Press/Total Gym 0-45 degrees (low resistance)
- Mini-Squats 0-45 degrees
- Double leg calf raises, progress to single leg as tolerated
- Continue well-leg Theraband exercises with brace on
- Single balance activities with brace on
Goals: ROM 0-60 degrees, minimal effusion, normal patellar mobility, no incision restrictions
Phase III (Weeks 4-6)
- Long leg brace locked at 0 degrees
- May D/C crutches if good quad control (can do 30 SLR without lag, normal gait)
- Initiate bicycling for endurance and ROM (do not exceed 90 degrees)
- Progress ROM to 0-90 degrees (do not exceed 90 degrees)
- Progress closed chain quad strengthening up to 60 degrees
- Single leg calf raise
- Stairmaster (brace off)
- Continue HS/gastroc/soleus stretching
- Continue balance training: cone walking, single leg balance, well-leg tubing, BAPS in parallel bars, body blade, plyoback
- Pool walking, closed chain pool exercises
Goals: Normal gait, no effusion, ROM 0-90 degrees, single leg balance x 30 secs
Phase IV (Weeks 7 to 12)
- Fit for functional brace
- Continue bicycle and stairmaster for endurance
- Begin Treadmill: forward and backward walking
- Elliptical
- Progress ROM to 0-115 degrees (do not exceed 115 degrees)
- Continue HS/gastroc/soleus stretching
- Initiate prone/standing HS curls…no resistance yet
- Progress closed kinetic chain exercises as tolerated…lateral step downs, etc
- Progress balance/proprioception activities…BAPS, plyoback, etc
- Progress in pool therapy
Goals: ROM 0-110 degrees walk 2 miles at 20 min/mile pace
Phase V (3-4 months)
- Brace used for strenuous exercise only
- Continue bike or Stairmaster for endurance
- Progress closed chain exercises
- Increase HS exercises gradually (light weight)
- Progress balance/proprioception activities
- Jog on mini-tramp/hop on mini-tramp
- Pool: running, hopping/jumping in water/kick board swimming
- Begin easy plyometrics: cone hopping (double leg), jump off 1 step, etc
- Begin agility drills/sports specific drills (shuffles, carioca, figure 8, etc)
- When jogging gait is normal, quad strength is 5/5 and can hop 10 times on affected limb without pain, begin straight-line walk/jog progression on flat surface
Goals: Full ROM, walk/jog 2 miles at 15 min/mile pace
Return to Activity (5 to 6 months)
- Progress running as tolerated
- Progress agility drills/sports specific drills
- Plyometric progression
- Continue LE stretches…include prone quad stretching
- Return to competitive sports at 6 months post-op if goals are met (see 6 month goals)
6 months Goals:
- No effusion or giving out
- Functional tests at least 90% of opposite leg to clear for sports and discharge (single leg hop and 12 meter hop for time)
No contact sports until 9 months post-op |
