General Considerations:

• Non-weightbearing status for 4 weeks post-op (resting foot on floor and driving are okay)
• Patients may be in a hinged brace for support and to serve as a reminder not to weight-bear.  May wear unloading brace once swelling is down enough for proper fit.
• Push for full hyperextension equal to opposite side
• Regular manual treatment should be conducted to the patella and all incisions--with particular attention to the anterior medial portal--to decrease the incidence of fibrosis
• Light to no resistance stationary cycling is okay at 2 weeks post-op
• Early recruitment of the vastus medialis muscle is important
• No resisted leg extension machines (isotonic or isokinetic) at any point
• Low impact activities for 3 months post-op
• Daily 1500 mg of Glucosamine Sulfate via Joint Juice or other sources
• Sof Sole insole or equivalent ASAP

*Use of the CPM for 6 hours a day for 4 weeks is imperative

Week 1:

• M.D. visit day 1 post-op to change dressing and review home program
• Icing and elevation frequently per instruction
• CPM at home for 6 hours daily/at night
• Straight leg raise exercises (lying, seated, and standing), quadricep/adduction/gluteal sets, passive and active range of motion exercises
• Hip and foot/ankle exercises, well-leg stationary cycling, upper body conditioning
• Pool/deep water workouts after the first week
• Soft tissue treatments and gentle mobilization to posterior musculature and patella
• Twice per day: sit at edge of bed and allow knee to bend to 90 degrees or less for 1-2 minutes.  Should feel a stretch with mild discomfort, but not sharp pain.
• Knee extension range of motion should be full

Weeks 2 - 4:

• M.D. visit at 8 - 10 days for suture removal (if any) and check-up
• Manual resisted (PNF patterns) of the foot, ankle and hip; core stabilization
• Continue with pain control, range of motion, soft tissue treatments and exercises
• Nonweightbearing aerobic exercises (i.e. unilateral cycling, UBE, Schwinn Air-Dyne arms only)
• AFTER 2 weeks, bilateral cycling with light to no resistance.  Low spin cadence

Weeks 4 - 6:

• M.D. visit at 4 weeks post-op, will progress to full weightbearing weaning down to 1 crutch, cane, or no assistive device
• Incorporate functional exercises (i.e. squats, lunges, Shuttle/leg press, calf raises, step-ups/lateral step-ups)
• Balance/proprioception exercises
• Road cycling as tolerated
• Slow to rapid walking on treadmill (preferably a low-impact treadmill)
• Seek knee flexion range of motion

Weeks 6 - 8:

• Increase the intensity of functional exercises (i.e. add stretch cord for resistance, increase weight with weightlifting machines)
• Add lateral training exercises (side-stepping, Theraband resisted side-stepping)
• Patients should be walking without a limp and range of motion should be full

Weeks 8 - 12:

• Low-impact activities until 12 weeks
• Patients should be pursuing a home program with emphasis on sport/activity-specific training