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Quad tendon repair with allograft post-operative physical therapy protocol

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General considerations

  • The surgical leg will be weight bearing as tolerated using crutches post-operatively.
  • Range of motion will be blocked at 0 degrees in a brace for 4 weeks.
  • No range of motion until 2 weeks, at 2 to 4 weeks 0 to 20 degrees. At 4 to 6 weeks 0 to 50 degrees.
  • Important not to push for flexion to quickly to protect the repair.
  • Avoid bandaged area and portals for 4 weeks, “no touch zone” 2 inches from portals.
  • Focus on proper quadriceps activation, especially VMO recruitment and patellofemoral mechanics should be the emphasis in the early stages of recovery.
  • Continue fitness through upper extremity, trunk, and cardiovascular exercise.

Week 1

  • M.D., office visit day 2 for dressing change, review of medications and instruction on a home program.

Exercises

  • Ankle pumps, quad sets, leg raises in multiple planes (except hip flexion).
  • Extension stretching to hamstrings, calves, and lateral musculature to maintain extension range of motion.
  • Well-leg stationary cycling and Upper Body Ergometer. Upper body weight machines and trunk exercises.
  • Gait training with crutches, pain and edema control, and muscle stimulation to improve quadriceps recruitment.

Manual

  • Soft tissue mobilization to surrounding musculature; effleurage for edema.

Goals

  • Decrease pain and edema.
  • Gait weight bearing as tolerated with brace locked in 0 degrees extension.
  • No Range of Motion.

Weeks 2 - 4

  • Nurse visit at 14 days post-operative for suture removal.

Exercises

  • Continue to progress weight bearing and functional mobility as able.
  • Active open chain hip extensions, adductions, abductions progressing to resistive band exercises as appropriate (proximal to the knee).
  • Standing calf raises. Straight legged bridging on ball with brace on.
  • Well legged cycling, upper body work outs.

Manual

  • Soft tissue mobilization surrounding structures, patellofemoral joint,and suprapatellar pouch with appropriate intensity to allow maturation and healing.

Goals

  • Decrease pain and edema.
  • Gait weight bearing as tolerated with brace locked in 0 degrees extension.
  • At 2 weeks okay to start 0 to 20 degree range of motionŃŽ

Weeks 4 - 6

  • M.D. visit at 1 month post-op. Wean out of brace, use brace unlocked if approved by MD.

Manual

  • Continue soft tissue mobilization. Initiate gentle patellar glides and portal scar tissue mobilization when appropriate.

Exercises

  • Ankle and hip resisted PNF patterns.
  • Single leg balance with perturbations (Around the worlds, single balance with upper extremity movements).
  • Prone on ball with added hip motions.
  • Continue well legged cycling and upper body work outs.

Goals

  • Range of motion 0 to 50 degrees.

Weeks 6 - 8

Exercises

  • Begin functional exercises such as partial squats, bent leg bridges, small range slider lunges, mini step ups.
  • Proprioceptive training. Continue to increase intensity and resistance of other exercises.
  • Two-legged bicycling for range of motion and without resistance and without forcing range of motion.
  • Emphasis on gait training with proper movement patterns.

Manual

  • Soft tissue mobilization through hip, knee, and lumbar region as necessary.
  • PNF patterns with resistance above the knee for hip and pelvic patterns.
  • Patellar decompression with taping techniques as needed.

Goals

  • Focus on gait mechanics. Range of motion 0 to 100 degrees.
  • Initiate stationary bicycle no resistance/pain.

Weeks 8 - 12

  • Initiate gentle passive flexion stretching to increase range of motion by 10 weeks.
  • Add lateral exercises (i.e. lateral stepping, lateral step-ups, etc.).
  • Continue all exercises with emphasis on closed-chain, functional and proprioceptive program. Increase unilateral closed chain activities. Increase resistance of cycling.

Goals

  • Passive/Active range of motion full, equal to opposite leg.
  • Gait no limp, good mechanics. Full range squat no pain. Stair management no pain.

Weeks 12 - 16

  • MD appointment at 12 weeks. Complete Sports test 1.
  • Goals are to increase strength, power, and cardiovascular conditioning.
  • Sport-specific exercises and training program. Eccentric focused strengthening program.
  • Begin gym strengthening including leg press. Increase proprioceptive drills.
  • Begin pre-running program (see handout for specific instructions) as able to demonstrate good strength and mechanics.

Months 4 - 6

  • Goals are to develop maximal strength, power, and advance to sporting activities.
  • Resisted closed-chain rehabilitation through multiple ranges.
  • Running program, balance drills and agility program.
  • Initiate plyometric training as able to demonstrate adequate strength and proper mechanics.

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.