General Considerations:

• Passive and active range of motion between 30 - 70 degrees for 4 weeks.  Patient will be instructed to come out of the brace once a day for extension range of motion stretching beginning week 2.
• Crutch assisted weight bearing progressing to full as tolerated.
• Regular attention should be paid to the incisions to decrease fibrosis and scarring--with particular emphasis on the anterior and lateral incisions.
• Exercises and manual treatments should also focus on early quadriceps and VMO recruitment.
• Patients are given a functional assessment/sport test at 2, 3, and 4 months post-op

Week 1:

• M.D. visit day 1 to change dressing and review home program.
• Icing and elevation as much as able.
• Straight leg raise exercises (lying, seated, and standing), quadriceps/adduction/gluteal sets, gait training, passive and active range of motion exercises within guidelines.
• Balance and proprioception exercises.              
• Soft tissue treatments and gentle mobilization to posterior musculature, patella and incisions.

Weeks 2 - 4:

• M.D. visit at 8 - 10 days.
• Incorporate functional exercises (i.e. squats/knee bends, modified lunges, step-ups).
• Instruct on once a day, passive extension stretching.
• Continue with pain control, range of motion, gait training, soft tissue treatments and balance & proprioception exercises.
• Pool workouts after the incisions are healed and with the use of the brace.
• Aerobic exercises as ROM allows (i.e. VersaClimber, stair machine, UBE, NordicTrac).

Weeks 4 - 6:

• M.D. visit at 4 weeks, will discontinue use of post-op brace at that time (may wean off brace with full range of motion if significant weakness or apprehension).
• Push for full range of motion with emphasis on extension.
• Increase intensity of all exercises with focus on closed-chain, functional progression.
• Stationary and road cycling as tolerated.

Weeks 6 - 8:

• Continue to increase the intensity of exercises (i.e. stretch cord resistance, adding weight, increasing resistance of aerobic machines).
• Add lateral training exercises.
• Begin to incorporate sport- or activity specific training.

Weeks 8 - 15:

• Progression of program of increasing intensity to return to sports and activities of daily living.
• Incorporate bilateral jumping exercises once able to demonstrate adequate strength.  Watch for compensatory patterns with take-offs or landings.

Weeks 12-20:

• Patients are not scheduled for another M.D. appointment until 3 - 4 months post-op.  At this point, range of motion should be at or near 100 % and any restrictions or concerns should be communicated to our office.