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