General Considerations:

-Partial weight-bearing status for 4 weeks post-op. 10-20% toe-touch for 1-2 weeks, progress as tolerated.
-Most patients will be in a hinged rehab brace locked in full extension for 4 weeks post-op unless otherwise indicated.
-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 and seated with feet off the ground, gently 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) straight leg raise exercises (lying, seated, and standing): quadriceps/adduction/abduction/gluteal sets;
2) twice daily passive and active range of motion exercises;
3) theraband calf presses;
4) well-leg stationary cycling;
5) upper body training; and
6) core/trunk training.

-Soft tissue treatments to musculature for edema and pain control.
-Manual daily patella glides up/down/side to side by therapist and patient.

Weeks 2 - 4:
-M.D. visit at 8 - 10 days for suture removal and check-up.
-GENTLE and BRIEF pool / deep water workouts after the first 8-10 days and with the use of a brace. No more than 30 minutes per workout; no more than 3 workouts per week.
-Continue with pain control, gentle range of motion, and soft tissue treatments.
 
Weeks 4 - 6:
-M.D. visit at 4 weeks post-op, will progress to full weight bearing and discontinue use of rehab brace.
-Increase stretching and manual treatments to improve knee range of motion. Extension should be full, and flexion should be near 100 degrees.
-Incorporate functional exercises (i.e. partial squats, calf raises, mini-step-ups, light leg pressing, proprioception).
-Stationary bike and progressing to road cycling as tolerated.
-Slow walking on treadmill for gait training (preferably a low-impact treadmill).
-Gait training to normalize movement patterns.

Weeks 6 - 8:
 -Increase the intensity of functional exercises (i.e. cautiously increase depth of closed-chain exercises., Shuttle/leg press).  Do not overload closed- or open-chain exercises.
- Continue to emphasize normal gait patterns.
-Range of motion: extension full, and flexion to 120 degrees.

Weeks 8 - 12:
-Add lateral training exercises (side-step ups, Theraband resisted side-stepping, lateral stepping).
-Introduce more progressive single leg exercise.
-Patients should be pursuing a home program with emphasis on sport/activity-specific training.
-Range of motion should be near normal.

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