Phase I (Day 0 to Day 2‐3) Rehab:
Goals:
- Control swelling, inflammation, and pain
- Initiate Therapeutic Exercise program(both involved and non‐involved leg)
- o Include Quad Sets, Hamstring Sets, Glut Sets
- o Heel slides, Ankle Pumps
- Safe ambulation with walker or crutches
- Safe and independent bed mobility and transfers
- ROM to 90 degrees flexion, 0 degree extension
To be carried out in the hospital
- Patient education
- Analgesia (cold compress)
- CPM per hospital or physician protocol
- Initiate Quad sets, hamstring sets, glut sets, ankle pumps, heel slides(Bilaterally)
- Standing and ambulation with Physical Therapist using a walker
- Stair climbing if relevant
- Bed mobility, transfer training (bed to stand/ to chair/ to toilet)
- Occupational Therapy to see patient for independence in ADL’s such as dressing and personal hygiene
- Discharge to home when patient meets discharge criteria.
- Discharge planning to arrange for any assistive devices/cpm/home health
- Discharge to Post‐op week 2:
Goals:
- Safe functionally within the home
- control of pain and inflammation
- Progression of HEP
- Increase ROM to 0‐100 degrees.
- Initiate Out Patient PT (Patient must be discharged from Home Health
PT/OT and nursing care for more than 72 hours prior to initiating outpatient PT)
Treatment:
- Muscle re‐education: Initiate quad contractions, SLRs, Short Arc Quads and Long Arc Quads, Bridging.
- Soft tissue mobilization for scar management
- PROM/assisted stretch/Grade 1‐2 joint mobilization
- AAROM using ‘dangle and drop’, Sliderboard, etc. include proning and propping to increase extension.
- Stationary Bike on low resistance, ‘Rocking’ if unable to perform
Revolutions
- Modalities for controlling pain and inflammation.
- Exercise for non‐involved limbs to maintain functional strength
- Gently increasing weight bearing tolerance in gait
- continue gait training to include steps/stairs and varied surfaces
- Consider Pool therapeutic exercise if incision is healed and Surgeon
- Approves and pool is available.
Phase II Rehab (Week 3 to Week 6):
Goals:
- Regaining endurance
- Increased co‐ordination and proprioception
- Further strengthening of knee muscles and kinetic chain (P.R.E.)
- Improvement of ROM to 100‐110 degrees
- Restore normalized gait
- Control pain and inflammation
- Maintain strength and endurance in non‐involved limbs and trunk
- Progress HEP
Treatment:
- Bike with resistance as tolerated
- WBAT: wean off walker in 1‐2 weeks to a cane, wean off all assistive devices by 4 weeks. Functional stair climbing with normal use of both legs
- Strengthening exercises in OKC (SLRs, TKE, hamstring curls) and CKC (minisquats, heel and toe raises, small step ups, TKE, sports cord, leg press, Total Gym, reformer)
- Joint mobilization and assisted ROM
- Proprioceptive exercises using wobble boards, trampolines, pneumatic disks
- Modalities to control pain and inflammation
- Continue ther ex for non‐involved regions to maintain needed functional Strength
- Progress HEP
Phase III Rehab (weeks 7‐12):
Goals:
- Returning the patient to their premorbid status (ADLs, walking for exercise)
- Further improvement of ROM past 110 degrees
- Gain eccentric‐concentric control of limb
- Walk independently without assistive devices without community barriers
- Greater emphasis on patient responsibility of their own exercise regimen (owning the HEP)
- Discharge planning
Treatment:
- Directed to residual restrictions in ROM, Strength, or function
- Progress HEP and determine independence in preparation for discharge
- Modalities for any pain or inflammation control