Nathan WM. Skelley, M.D.

Phase I (0 - 6 weeks)

Appointments

• Home exercise program will begin after surgery

• 2-3xwk or as designated by rehabilitation specialist

Rehabilitation Goals

• Protection of healing tissue from load and shear forces

• Decrease pain and effusion

• Restoration of full passive knee extension

• Gradual improvement of normal knee flexion

• Regaining quadriceps control and patella mobility

Brace/Weight bearing

• Locked in extension

• Sleep in locked brace

• Non-weight bearing

Suggested Therapeutic Exercise

• Immediate motion exercises, full passive knee extension

• CPM 4-6 hours per day 0-40 degrees, increase by 5-10 degrees

  per day as tolerated

• Range of motion goals: 90 degrees by 2 weeks and 115 by four

  weeks and 125 by six weeks

• Patellar and soft tissue mobilization

• Hamstring, calf, and quadriceps stretching

• Ankle pumps, quad sets, multi-angle isometrics, active knee

  extension 90-40 degrees, SLR 4 directions, stationary bike, biofeedback and EMS,

Cardiovascular exercise

• Upper body circuit training or upper body ergometer (UBE)

Progression Criteria

• Progress two weeks post-operatively

 

Phase II (6-12 weeks)

Appointments

• Rehabilitation appointments are 1-3 times per week

Rehabilitation Goals

• Gradually increase ROM and WB to full

• Gradually improve quadriceps strength/endurance

Brace/Weight Bearing Status

• Discontinue use of brace

• Progress weight bearing as tolerated by increasing 25%/week

  until full WB

• Discontinue crutches at 12 weeks

Suggested Therapeutic Exercise

• Range of motion: 125-135 degrees

• Continue patellar mobilization and soft tissue mobilization as

  needed

• Continue stretching program

• Week 6: initiate weight shifts

• Week 8: Initiate mini-squats 0-45 degrees, closed chain

  activities

• Week 10: toe-calf raises, open kinetic chain knee extension,

  stationary bike, balance and proprioception, front and lateral step ups, continue biofeedback and EMS,

Cardiovascular exercise

• Upper body circuit training or UBE, bike as range of motion allows

Progression Criteria

• Full range of motion

• Acceptable strength level, quadriceps within 15% of

  contralateral leg and hamstrings within 10% of contralateral

• Balance testing within 30% and single leg balance >15 seconds

• Able to bike for 30 minutes

 

Phase III (3-6 months post-operatively)

Appointments

• Rehabilitation appointments are once every 1-2 weeks

Rehabilitation Goals

• Improve muscular strength and endurance

• Increase functional activities

Precautions

• Avoid post-activity swelling

• Post activity soreness should resolve after 24 hours

• Avoid pain with knee strengthening activities

Suggested Therapeutic exercises

• Range of motion: no restrictions – obtain full motion

• Leg press 0-90 degrees, Bilateral squats 0-60 degrees

• Unilateral step-ups progressing from 2-8”step

• Forward lunges

• Walking on treadmill

• Open kinetic chain extension 0-90 degrees

Cardiovascular exercise

• Upper body circuit training or UBE, non-impact lower body exercises including bike, elliptical, swimming, stair climber

Progression criteria

• Full non painful ROM

• Strength within 90%

• Balance and/or stability within 75%

• No pain, inflammation or swelling

 

Phase IV (6 months post-operative)

Appointments

Rehabilitation appointments are once every week

Rehabilitation Goals

Proprioceptive and muscular control with work and sport specific activities

Precautions

• Post activity soreness should resolve in 24 hours

• Avoid post activity swelling

• Avoid knee pain with higher impact activities

Suggested Therapeutic exercises

• Continue maintenance program progression 3-4x/wk.

• Progress resistance as tolerated

• Emphasis on entire lower extremity with strength and

  flexibility

• Progress agility and balance drills

• Impact loading program should be specialized to the patient’s

  demands

• Progress sport/work program

Cardiovascular exercise

• Replicate sport/work

Return to sport/work criteria

• Patient may return to various sport activities as progression in rehabilitation and cartilage healing allows. Generally, low impact sports such as skating, rollerblading, and cycling are permitted at about 8 months. Higher impact sports such as jogging, running, and aerobics may be performed at 8-10 months. High impact sports such as tennis, basketball, soccer and baseball are allowed at 10-12 months.