Nathan WM. Skelley, M.D.

Phase I (Surgery to 8 weeks postoperative)

Appointments

• Home exercise program will begin after surgery

• PT 1-3x/week

Rehabilitation Goals

• Protection of the post-surgical knee

• Eliminate effusion

• Restore leg control

Precautions

• Weight bearing: NWB with crutches for first 4 weeks, then gradually increase WB locked in extension

• Brace: locked in extension

• Range of motion: no greater than 90 degrees with therapy or when seated

Suggested Therapeutic Exercise

• Range of motion: Heel props, prone hands, supine wall slides, knee flexion off edge of table

• Quad sets, hamstring sets

• SLR 4 directions with brace

• Heel slides to 90 degrees

• Abdominal isometrics

Cardiovascular exercise

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

Progression Criteria

• 8 weeks postoperative

• Pain free gait without crutches

• No effusion

 

Phase II (weeks 8-12 weeks)

Appointments

• Rehabilitation appointments are 1-3 times per week

Rehabilitation Goals

• Single leg stand control

• Normalize gait

• Good control and no pain with functional movements

Precautions

• No forced flexion

• Weight bearing flexion limited to 60 degrees

• Avoid post-activity swelling

• No impact activities

Suggested Therapeutic Exercise

• Non-impact balance and proprioceptive drills

• Stationary bike

• Gait training

• Hip and core strengthening

• Stretching

• Quad strengthening

Cardiovascular exercise

• Non-impact training including stationary bike, elliptical, swimming, aqua jogging

Progression Criteria

• Normal gait on all surfaces

• Ability to carry out function movements without unloading

  affected leg or pain

• Single leg balance greater than 15 seconds

 

Phase III (12-16 weeks post-operatively)

Appointments

• Rehabilitation appointments are once every 1-2 weeks

Rehabilitation Goals

• Good control and no pain with sport and work specific movements, including impact

Precautions

• Post-activity soreness should resolve within 24 hours

• Avoid post-activity swelling

• Avoid posterior knee pain with end range knee flexion

Suggested Therapeutic exercises

• Impact control exercises

• Closed chain strengthening for quad and glutes with

  progression

• Single leg balance exercises with progression

• Hip strengthening

• Core strengthening and stabilization

• Begin plyometric training

Cardiovascular exercise

• Replicate sport or work specific energy demands

Return to sport/work

• Dynamic neuromuscular control with multi-plane activities without pain or swelling

 

Phase IV (20 weeks post-operative)

Appointments

• Rehabilitation appointments are once every week

Rehabilitation Goals

• Normal multi-planar high velocity equal bilaterally without compensation

• Normal plyometric form equal bilaterally without compensation

Precautions

• No active reactive swelling or joint pain that lasts more than 12 hours

Suggested Therapeutic exercises

• Progressive agility drills

• Landing mechanics

• Movement control exercises

• Proprioceptive drills

• Sport/work specific drills

• Hip strengthening

• Core strengthening and stabilization

• stretching

Cardiovascular exercise

• Replicate sport/work, progressive running program

Return to sport/work criteria

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

• Physician and rehabilitation specialist approval