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.