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Preoperative Guidelines
- Restore full AROM (unless mechanically locked by meniscus)
- Teach normal heel-toe gait
- Strengthen involved extremity
- Decrease effusion
- Educate Patient on post-op protocol, use of crutches (level and stairs)
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)
- Weight bearing depends on surgical procedure and MD recommendations
- No active HS exercises against gravity or with weights
- Brace – locked in extension for ambulation…Can unlock for exercise only
- Patellar mobilization (teach patient)
- Calf pumping
- AAROM 0-90 degrees…But will depend on surgical procedure and MD recommendations.
- PEAF (passive extension-active flexion), heel slides – Limit to 0-90 degrees
- Passive extension with heel on bolster or prone hangs
- Electrical stimulation in full extension with quad sets and SLR
- SLR x 4 (parallel bars if poor quad control)
- Double leg heel raises
- Gentle HS stretching, calf stretching, hip stretching
- Ice pack with knee in full extension after exercise
Goals: Independent SLR x 10 without lag, 0-0-70 degrees AROM, pain and effusion controlled
Phase II (Weeks 3 – 4)
- Brace – locked in extension for ambulation
- Crutches – Weight bearing depends on surgical procedure and MD recommendations.
- Continue appropriate previous exercises and patellar mobilizations
- Scar massage when incision healed
- PROM, A/AROM, AROM 0-90 degrees only Unless approved by MD to increase ROM
- SLR x 4 – add light ankle weights if quad control is maintained
- Weight shifts (partial support in parallel bars)…Depends on WB status
- Begin progressive closed chain exercises starting with light resistance (i.e. supine leg press) and not > 0-45 degrees staying within WB restrictions.
- Stretches – HS, AT, Hip Flexors, ITB
- Pool Therapy for gait training (no kicking). Stay within ROM restrictions
Goals: Pain/effusion under control, No extensor lag with SLR x 30, AROM 0-0-90
Phase III (Weeks 5 – 8)
- Brace – Locked in extension for ambulation (MD may D/C it sooner: check with MD)
- Crutches – Weight bearing depends on surgical procedure and MD recommendations.
- Continue appropriate previous exercises
- PROM, AAROM, AROM with goal of 120 degrees by 8 weeks
- Hamstring curls 0-45 – closed chain (carpet drag, rolling stool)
- Stationary bike with seat high for ROM – complete cycle as able
- Well-leg Theraband… Depends on WB status
- Mini squats, Total Gym no > 45 degrees knee flexion…Depends on WB status
- Mini Wall sits for time no > 45 degrees knee flexion… Depends on WB status
- Treadmill walking progression…Depends on WB status.
- Pool therapy – Walking and jogging (no kicking)
Goals: AROM 0-0-120 degrees, no effusion, independent ambulation FWB without deviation
Phase IV (Weeks 9-12)
- WBAT, D/C crutches when gait is WNL
- Continue appropriate previous exercises
- PROM, AAROM, AROM – gradually increase motion
- Partial wall squats – No knee flexion past 45 degrees
- Lateral step downs – No knee flexion past 45 degrees
- Single leg heel raises
- Proprioceptive training – single leg standing balance, Double leg BAPS for weight shift,
- Progress to single leg BAPS, Plyoback, and body blade
- Functional activities – Fitter, slide board
- Well-leg Theraband
- Hamstring curls 0-90 – progress gradually (may begin open-chain)
- Stationary bike for progressive resistance and time
- Treadmill – Backwards and forwards walking…Progress in speed and distance
- Elliptical trainer
- Pool therapy – unrestricted
Goals: Full ROM, Normal gait, Walk 2 miles at 15 min/mile pace without effusion/edema
Phase V (Months 3 – 4)
- No squatting >90 degrees
- Continue appropriate previous exercises
- Gym program: gradually increase closed chain ROM and resistance
- Agility drills/carioca/lateral shuffle/light plyometrics/double hopping
- Full hamstring curls – Open/closed chain
- Treadmill – Begin speed walking to jogging program if normal gait
- Quad stretches
- Pool therapy – Plyometrics: hopping single leg, bounding, etc
Goal – Jog 2 miles at easy pace with normal gait and no increase in pain/edema/effusion
Phase VI (Months 4 – 6)
- Home/gym program
- Plyometrics progression
- Begin cutting/ sports specific drills
- Continue strengthening, stretching, proprioceptive training, and running
Goals: 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 6 months post-op
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