Nathan WM. Skelley, M.D.

Post-Operative Period

1 week to 1 month:

1. 1 to 2 visits per week, every day home program
2. Quad sets, may use electrical stimulation, increase # visit/week if quad inhibited
3. Patellar mobilizations, especially superiorly and medially (as tolerated)
4. Straight leg raises, full arc quads without weights
5. Prone knee flexion, heel slides, calf and hamstring stretching
6. Icing program, 3 to 5 times a day, 30 minutes each after exercises
7. Knee brace locked at 0 degrees extension when ambulating
8. Flexion limited to 90 degrees for 4 weeks
9. Prone lying and gentle stretching to achieve full extension (if full extension is allowed)
10. Weightbearing as tolerated with crutches for 4 weeks with brace locked in extension, no exceptions!

 

1 to 3 months:

1. 2 visits per week, 5 times a week home program.
2. Continue all exercises in previous phase (as described above).
3. Patellar mobilizations, especially superiorly and medially.
4. Gait training to walk without a limp with crutch assistance should be primary goal of this stage.
5. Work to regain full flexion during this phase.
6. Brace may be unlocked at all times except for weightbearing (keep locked until quad control is strong).

7. Crutches and brace should be weaned off by 6 to 8 weeks.

 

3 to 4 months:

1. 2 to 3 visits per week, 5 times a week home program.
2. Continue exercises in previous phase (as described above).
3. Begin quad exercises including mini-squats, wall slide mini-squats, leg presses, hamstring curls, all with light

weights and high repetitions – avoid leg extensions.
4. Toe raises with weights, step-ups (begin with 2 inches and progress to a full step).
5. Endurance closed-chain quadriceps exercises should begin such as Stair Climber, stationary bike, elliptical

trainer, etc. Focus on increasing endurance and should be performed 3 to 4 times per week.
6. Continue gait training, including progression to fast walking on a treadmill or even ground.
7. If a pool is available, swimming may be started, but the frog-kick and breaststroke should be avoided.

8. Gait and range of motion should be normal by the end of this phase. If it is not, contact Dr. Skelley.

 

4 to 5 months:

1. 3 to 5 times a week home program. May need physical therapy supervision for functional training.
2. Begin advanced strengthening with weights including leg presses, squats, leg curls, and lunges – Avoid leg

extensions.
3. Initiate plyometric program as appropriate for patient’s functional goals.
4. May begin functional training exercises including fast straight running, backward running, cutting, cross-

overs, etc.
5. Begin gradual return to previous sports/activities/work duties under controlled conditions.
6. Full return to sports/activities/full work duties are pending Dr. Skelley’s approval based upon the following criteria:

 

Criteria for Return to Sports/Full Activities:

1. Quadriceps and hamstring strength at least 90% of opposite leg.
2. One-leg hop test and vertical jump at least 90% of opposite leg.
3. Jog, full speed run, shuttle run, and figure of 8 running without a limp.

4. Squat and rise from a full squat.
5. No effusion or quadriceps atrophy.