General Considerations:
-Weight-bearing as tolerated status. Walk with crutches.
-Surgical knee will be in a hinged rehab brace locked in FULL EXTENSION for 4 weeks post-op.
-Regular assessment of gait to avoid compensatory patterns.
-Regular manual mobilizations to surgical wounds and associated soft tissue to decrease the incidence of fibrosis.
-No resisted leg extension machines (isotonic or isokinetic).
-No high impact or cutting / twisting activities for at least 4 months post-op.
-M.D. follow-up visits at Day 1, Day 8-10, 1 month, 4 months, 6 months, and 1 year post-op.
-During the first 4 weeks: TWICE PER DAY: Without brace, allow GRAVITY ONLY to bend knee back as tolerated BUT NO MORE THAN 90 DEGREES for a good knee stretch without increase in pain. Relax knee and stretch for 60 seconds.

Week 1:
-M.D. visit day 1 post-op to change dressing and review home program.
-Icing and elevation regularly. Aim for 5x per day, 15-20 minutes each time. For ice machine: use as directed.
-Exercises: 1) quad-sets 10 sec. holds every 30 minutes; 2) straight leg raise exercises (lying, seated, and standing): quadriceps/adduction/abduction/gluteal sets; 3) once daily passive and active range of motion exercises; 4) ankle pumps throughout the day; 5) well-leg stationary cycling; 6) upper body conditioning.
-Pool / deep water workouts after the first 8-10 days once surgical wounds are healed and with the use of a brace.
-Soft tissue treatments for edema / pain control and to posterior musculature, patella and incisions.
-Knee extension range of motion should be full.

Weeks 2 - 4:
-M.D. visit at 8 - 10 days for suture removal and check-up.
-Manual resisted exercises (i.e. PNF patterns) of the foot, ankle and hip. Trunk stabilization program. Single leg balance exercises.
-Continue with pain control, range of motion, soft tissue treatments and proprioception exercises.
-Non-weightbearing aerobic exercises (i.e. unilateral cycling, UBE, Schwinn Air-Dyne with uninvolved leg and arms only, pool workouts).

Weeks 4 - 6:
-M.D. visit at 4 weeks post-op, will wean off the use of rehab brace.
-Stretching, exercises and manual treatments to improve range of motion (especially flexion).
-Incorporate functional exercises (i.e. partial squats, calf raises, mini-step-ups, proprioception).
-Stationary bike and progressing to road cycling as tolerated.
-Slow walking on treadmill for gait training (preferably a low-impact treadmill).
Weeks 6 - 8:
-Increase the intensity of functional exercises (i.e. cautiously increase depth of closed-chain exs.,
Shuttle/leg press). Do not overload closed or open-chain exercises.
-Patients should be progressing to walking without a limp and flexion range of motion should be at 80%.

Weeks 8 - 12:
-Add lateral training exercises (side-step ups, Theraband resisted side-stepping, lateral stepping).
-Introduce more progressive closed chain and agility leg exercises.
-Patients should be pursuing a home program with emphasis on sport/activity-specific training.
-Knee flexion range of motion should be equal to other knee.

Weeks 12-16:
-Low-impact activities until 16 weeks.
-Increase the intensity of strength and functional training for gradual return to activities.