REHABILITATION PROTOCOL to be followed
Week 1-2:
-Begin increasing weight bearing and wean from crutches
– Brace is to be used until 2 weeks post-op depending on ability to control the leg with ambulation.
-ROM should be 0-75 degrees and the patient should be able to straight leg raise.
-Early emphasis on achieving full extension with active VMO recruitment.
-Soft tissue treatments to patella, patella tendon, incisions, and posterior musculature to improve range of motion and decrease fibrosis.
Weeks 2-4:
-Range of motion exercises (i.e. wall/heel slides, passive stretching), pain control, gait training, and continue with soft tissue treatments.
-ROM should be 0-110 degrees by 3-4 weeks post-op.
-Incorporate functional, closed-chain focused exercises (i.e. mini-squats, modified lunges, leg press, calf exercises.). Emphasis on VMO control, core stability, and avoidance of varus / valgus moment with exercises.
-No active hamstring exercises until 2 weeks and no open-chain resisted hamstring curls until 4 weeks post-op.
Weeks 4-6:
-Continue with ROM focus if patient cannot actively move knee from 0-115. Soft tissue and scar mobilization for ROM and patella / tendon mobility.
-Increase intensity of functional exercises (i.e. add weight or resistance with exercises, incorporate stretch cord exercises, increase intensity with aerobic machines).
-Single-leg/unilateral workouts (i.e. on weight machines, squats, side and forward step-downs, Increase depth of balance exercises)
– Aggressive core stabilization program (i.e. physio ball, foam roller exercises).
Weeks 6-8: follow-up at 6 or 8 weeks. Will reduce number of visits to 1 per week.
– Introduce lateral training to demonstrate good mechanics and adequate strength.
– Carefully monitor exercises for signs of diminished eccentric control, weakness, or poor ability to stabilize against varus / valgus moment with loading exercises.
Weeks 8-10:
-Continued supervised care 1 x / week with particular emphasis on strengthening in the lower ranges of motion (i.e. from 30-80 degrees of knee flexion).
Weeks 10-12:
– 1 visit at 10 weeks and one visit at 12 weeks to review home program, increase intensity as indicated and monitor for guarding or compensation.
