Phase I: Immediate Postoperative Phase (Weeks1-4)
Goals:
- Wound healing
- Quadriceps activation
- Decrease effusion
- Restore full extension
- Normalize patella mobility
- Initiate proximal strengthening
Restrictions:
- WBAT with crutches with brace locked at 0
- D/C crutches after a few days unless radial tear (will be specified by physician)
- Keep brace locked at 0 when not in therapy/exercising
- Range of motion (ROM), motion is limited to 0-70 for 4 weeks,
Treatment:
- Ice, compression, elevation
- Electrical muscle stimulation
- Scar tissue mobilization
- Active assisted ROM
- Strengthening
- Quadriceps isometrics
- Hamstring isometrics
- Hip abduction/adduction
Clinical Milestones:
- +1 effusion
- Good quadriceps set
- Good patella mobility
- Painfree at rest
- AROM 0-70
- Single limb stance
Phase II Intermediate Postoperative Phase (Weeks 4-6)
Goals:
- WBAT with crutches with brace locked from 0-90
- Progress to closed kinetic chain exercises
- Avoid Patellar pain
Restrictions:
- Gradual increase in flexion ROM (based on pain assessment) to 90 degrees
- D/C brace at 6wks
Treatment:
- Pain Management
- Control of effusion
- Neuromuscular Re-ed of Quadriceps
- Mini Squats
- Step up's
- Upper extremity reaches
- ROM exercises
- Flexibility exercises
- Cardiovascular training
- Toe raises
- Cycling
Clinical Milestones:
- FWB
- Normal gait
- AROM 0-90
- Good quadriceps recruitment
- Straight leg raise without lag
- Normal patellar mobility
Phase III: Advanced Strengthening Phase (Weeks 6-10)
Goals:
- Increase strength, power, endurance
- Normalize knee ROM
- Prepare athlete for advanced exercises
Restrictions:
- Avoid pivoting
- Flexion to 130
- No squatting / No deep knee bends
Treatment:
- Progress quadriceps strengthening exercises
- Standing balance training
- Effusion/edema reduction
- Strengthening exercises
- Upper extremity reaches
- Lateral step-ups
- Leg press
- Step down's
- Endurance exercises
- Proprioception exercises
- Flexibility exercises
- Isokinetic exercises
- Swimming
- StairMaster
- Minisquats
- Cycling
- Nordic Track
Clinical Milestones:
- Improved stability with unilateral stance
- Minimal to no pain
- Achieve full ROM
- Equal hip strength bilaterally
- Isokinetic quadriceps strength < 20% contralateral
Phase IV: Return to Activity Phase (Weeks 11-16)
Goals:
- Increase power and endurance
- Emphasize return to skill activities
- Prepare to return to full unrestricted activities
Restrictions:
- Avoid hyperflexion
Treatment:
- Strengthening exercises
- Endurance exercises
- Agility drills
- Plyometric training
- Sport specific drills
- Initiate running program
- Initiate cutting program
Clinical Milestones:
- Full confidence in knee
- Painfree activity at 5 months
- Satisfactory clinical examination
- Functional testing at least 90% of contralateral leg
- Isokinetic testing least 90% of contralateral leg
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