Nathan WM. Skelley, M.D.

Phase I (0-6 weeks)

Appointments

• Home exercise program will begin after surgery – 2 weeks

• 1-3x/wk. from 2-6 wks.

Rehabilitation Goals

• Protection of the post-surgical knee

• Restore normal knee range of motion.

• Normalize gait.

• Incisions healed and effusion decreased.

• Restore leg control.

Precautions

• Brace locked in extension for gait and activities of daily living.

• Crutches for gait as needed with brace on, weight bearing as

  tolerated.

• Range of motion limited to 0-90 degrees.

Suggested Therapeutic Exercise

• Quadriceps sets.

• SLR 4 way with brace.

• Ankle pumps.

• Ankle isotonic exercises.

• Continuous Passive Motion Device as tolerated 0-90 degrees,

  advance as tolerated within this range.

Cardiovascular exercise

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

Progression Criteria

• Postoperative 6 weeks.

 

Phase II (weeks 6-12)

Appointments

• Rehabilitation appointments are 1-3 times per week.

Rehabilitation Goals

• Single leg stand control.

• Good control and no pain with short arc functional

  movements.

• Good quad control.

• Normalize gait brace unlocked.

Precautions

• Avoid over stressing fixation: begin movement control and gentle strengthening with closed chain movement in a shallow arc of motion and by using non-weighted techniques.

• Avoid post activity swelling.

Suggested Therapeutic Exercise

• Gait drills.

• Functional single plane closed chain movements.

• Continued gradual progress of range of motion.

• Gradual progress of lower extremity strengthening with

  precautions to avoid dynamic valgus or medial knee

  displacement.

• Balance and proprioception exercises.

• CPM as needed.

Cardiovascular exercise

• Upper body circuit training or UBE.

Progression Criteria

• Normal gait on level surfaces.

• Good leg control without extensor lag, pain or apprehension.

• Single leg balance greater than 15 seconds.

• At least 12 weeks postoperative.

 

Phase III (week 12-16)

Appointments

• Rehabilitation appointments 1-3xwk.

Rehabilitation Goals

• Full range of motion.

• No effusion.

• Improve quadriceps strength.

• Improve proximal hip and core strength.

• Improve balance and proprioception.

Precautions

• Avoid closed chain exercises past 90 degrees of flexion to avoid overstressing the repaired tissues and increased patellofemoral forces.

• Avoid post-activity swelling.

Suggested Therapeutic exercises

• Continue range of motion exercises and stationary bike.

• Closed chain strengthening begin with single plan with

  progression to multi-plane.

• Single leg press.

• Balance and proprioception exercises.

• Hip and core strengthening and stretching.

• Initiate low amplitude agility drill in the sagittal plane, avoid

  frontal and transverse initially due to potential for dynamic valgus.

Cardiovascular exercise

• Swimming with flutter kick, stair stepper.

• DO NOT RUN.

Progression Criteria

• Full range of motion.

• No effusion.

• No patellar apprehension.

• Single leg balance with 30 degrees of flexion greater than 15

  seconds.

• Good control and no pain with squats and lunges.

 

Phase IV (months 4-6)

Appointments

• Rehabilitation appointments 1-3xwk.

Rehabilitation Goals

• Good eccentric and concentric multi-plane dynamic. neuromuscular control (including impact) to all for return to work/sports.

Precautions

• Post activity soreness should resolve within 24 hours.

• Avoid post-activity swelling and pain.

Suggested Therapeutic exercises

• Impact control exercises with progression from 2 feet to 1.

• Movement control exercises with progression.

• Progression to multi-planar agility drills with progressive.

  increase in velocity and amplitude.

• Sport/work specific balance and proprioceptive drills.

• Hip and core strengthening.

• Stretching for patient specific muscle imbalances.

Cardiovascular exercise

• Replicate sport or work specific energy demands.

Return to work/sport

• Dynamic neuromuscular control with multi-plane activities and without pain, instability or swelling.

• Approval from the physician and/or sports rehabilitation provider.