• 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 to avoid stress on sutures/stitches.
• No two-legged biking or flexion exercises for at least two weeks. Well-leg biking is okay.
• Regular manual treatment should be conducted to the patella and all incisions so they remain mobile.
• Early exercises should focus on recruitment of the quadriceps.
• No resisted leg extension machines (isotonic or isokinetic) at any point in the rehab process.

Week 1

• Nurse visit day 2 for dressing change.
• Icing, elevation, and aggressive edema control (i.e. circumferential massage, compressive wraps) for 15 minutes every 2 hours.

Manual

• Soft tissue mobilization to the surrounding and posterior musculature, and to the patella to avoid flexion or patella contracture.
• Focus on extension for knee range of motion.

Exercises

• Straight leg raise exercises (standing and seated), passive and active range of motion exercises.
• Initiate quadriceps gluteal sets, gait training, balance/proprioception exercises.
• Well leg cycling and upper body conditioning.

Goals

• Decrease pain/swelling.
• Passive range of motion <90 degrees (secondary to stitches) x 2 weeks.
• Full weight bearing.

Week 2 - 4

• Nurse visit at 14 days for suture removal and check-up.

Manual

• Continue soft tissue mobilizations, decrease edema/pain.

Exercises

• 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, upper body ergometer).

Goals

• Decrease pain/swelling.
• Tolerate bilateral stationary cycling.
• Active range of motion 0-90 degrees.

Week 4 - 6

• M.D. visit at 4 weeks post-op.

Manual

• Continue soft tissue mobilizations, decrease edema/pain. Joint mobilizations for range of motion as needed.

Exercises

• 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).

Goals

• Normal gait pattern.

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).

Goals

• Active range of motion 0 to 110 degrees.
• Passive range of motion 120 degrees.

Week 8 - 12

• Completion of Sports Test I at 12 weeks.
• Begin to incorporate activity specific training (i.e. household chores, gardening, sporting activities).
• Low impact activities until week 12.
• No twisting, pivoting until after week 12.
• Patients should be weaned into a home/gym program with emphasis on their particular activity/sport.

Goals

• Road cycling.
• Walk downstairs with reciprocal gait.
• Full range of motion.

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.