General considerations:

• All times are to be considered approximate, with actual progression based upon clinical presentation.
• Patients are full weight bearing with the use of crutches, a walker or a cane to assist walking until they are able to demonstrate good walking mechanics.
• Early emphasis is on achieving full extension equal to the opposite leg as soon as able.
• No passive or active flexion range of motion greater than 90 degrees for the first two weeks.
• No two-legged biking or flexion exercises for at least two weeks. Well-leg biking is fine.
• Regular manual treatment should be conducted to the patella and all incisions so they remain mobile.
• Early exercises should focus on recruitment of the vastus medialis obliquus (VMO).
• No resisted leg extension machines (isotonic or isokinetic) at any point in the rehab process.

Week 1:

• Goal is to allow the medial arthrotomy to heal and decrease swelling.
• M.D. visit after hospital discharge to change dressing and review home exercise program.
• Icing, elevation, and aggressive edema control (i.e. circumferential massage, compressive wraps).
• Straight leg raise exercises (standing and seated), passive and active ROM exercises.
• OK to gently bend knee < 90 degrees 1-2x per day.
• Initiate quadricep/adduction/gluteal sets, gait training, balance/proprioception exercises.
• Well leg cycling and upper body conditioning.
• Soft tissue treatments and gentle mobilization to the posterior musculature, patella, and incisions to avoid flexion or patella contracture.

Week 2-4:

• M.D. visit at 14 days for suture removal and check-up.
• Continue with home program, progress flexion range of motion, gait training, soft tissue treatments, and balance/proprioception exercises.
• Incorporate functional exercises as able (i.e. seated/standing marching, , hamstring carpet drags, hip/gluteal exercises, and core stabilization exercises).
• Aerobic exercise as tolerated (i.e. bilateral stationary cycling as able, UBE, pool workouts once incisions are healed.)

Week 4-6:

• M.D. visit at 4 weeks post-op.
• Increase the intensity of functional exercises (i.e. progress to walking outside, introducing weight machines as able).
• Continue balance/proprioception exercises (i.e. heel-to-toe walking, assisted single leg balance). Slow to normal walking without a limp.

Week 6-8:

• Add lateral training exercises (i.e. lateral steps, lateral step-ups, step overs) as able.
• Incorporate single leg exercises as able (eccentric focus early on).
• Patients should be walking without a limp and range of motion should be < 10 degrees extension and > 110 degrees flexion.

Week 8-12:

• Begin to incorporate activity specific training (i.e. household chores, gardening, sporting activities).
• Low impact activities until after week 12.
• Patients should be weaned into a home/gym program with emphasis on their particular activity/sport