Phase I: (0-6 weeks)
Goals:
- Alleviate acute pain and swelling
- Increase ROM 0-90° (emphasize 0° extension)
- Increase hamstring and quadriceps strength
- Promote comfortable ambulation TDWB with brace and crutches
- Maintain cardiovascular conditioning
Plan: (0-2 weeks)
- Patellar mobilization
- PROM positioning for knee extension
- Quad isometrics with knee in full passive extension
- Ankle AROM as much as possible
- Knee ROM: Supine heel slides with terminal stretch to increase flexion to 90 degrees by 4 weeks postop; do not exceed
- ROM goal prior to 4 full weeks postop
- Gait training TDWB with brace locked in full extension
- Sit and allow knee flexion over edge of table to facilitate flexion to 90
- Hamstring and quadriceps co-contraction
- 4-Quad (hip flexion, abduction, adduction, extension) brace locked ext
- Modalities for pain and edema control
- Sleep in Brace
Plan: (3-4 weeks)
- Soft tissue/scar mobilization
- Emphasis on increasing ROM(full extension, flexion to 90 degrees)
- Continue crutches with brace locked at 0, TDWB
- Add supine SLR out of brace when able to do so with no extensor lag
- Side lying SLR begins
- EMS co-contraction at VMO and hamstrings’
- Theraband ankle exercises – progress to standing as WB dictates
- General conditioning
- Aquatic therapy (when incisions healed) No whip kick
- Continue sleep in brace
Plan: (5-6 weeks)
- ½ revolution non-resisted bike for knee flexion – progress to full rev. when patient reaches 110°
- Weight shifting in standing, 0-30° ROM mini squats
- Prone/standing knee flexion to 90 degrees
- Proprioceptive training/ balance — BAPS, trampoline
- Progress ROM to 110
- Rehab brace open 0 to 90, may wean from nighttime brace use as tolerated
- More aggressive patellar mobilization
- Progress to full WBAT
Phase II (7-12 weeks)
Goals:
- Decrease swelling and prevent atrophy
- Increase ROM -125°
- Increase quadriceps and hamstring strength
- Increase hip strength
- Stimulate collagen healing
- Independent ambulation without crutches
- Continue general conditioning
Plan:
- Continue phase I exercises
- Continue patellar mobilization and ROM activities
- Standing ½ squat
- Joint and soft tissue mobilization as needed
- Isotonic hamstring NK table
- Leg press
- Begin stair master gradual increase in endurance
- Continue closed chain, balance and proprioceptive activities
- Continue EMS as needed for muscle re-ed and edema
- Step-ups (controlled – forward and side)
- *McConnell tapping as necessary)
- General conditioning