Phase I – Maximum Protection (0 to 1 week):
0 to 1 week:
- Ice and modalities to reduce pain and inflammation
- Use crutches non-weight bearing for 8 weeks; progress off as instructed by physician
- Elevate the knee above the heart for the first 3 to 5 days
- Initiate patella mobility drills
- Begin full passive/active knee range of motion exercises
- Quadriceps setting focusing on VMO restoration
- Multi-plane open kinetic chain straight leg raising
- Gait training with crutches (NWB)
Phase II – Progressive Stretching and Early Strengthening (Weeks 1 to 8):
Weeks 1 to 8:
- Maintain program as outlined in week 0 to 1
- Continue with modalities to control inflammation
- Initiate global lower extremity stretching program
- Begin stationary bike and pool exercise program (when incisions healed)
- Implement reintegration exercises emphasizing core stability
- Closed kinetic chain multi-plane hip strengthening on uninvolved side
- Manual lower extremity PNF patterns
- Proprioception drill emphasizing neuromuscular control
- Multi-plane ankle strengthening
- Partial weight-bearing (up to 50%)
- Full Weight-bearing at 6 weeks post op
Phase III – Strengthening and Proprioceptive Phase (Weeks 8 to 12):
Weeks 8 to 10:
- Modalities as needed
- Continue with Phase II exercises as indicated
- As instructed by physician: Begin partial weight bearing at 25% of body weight and increase by 25% approximately 3 days. May progress to one crutch at 9.5 weeks as tolerated, gradually wean off of crutches by week 10-12.
Weeks 10 to 12:
- Normalize gait pattern
- Advance stationary bike program; begin treadmill walking and elliptical trainer; avoid running and impact activity
- Initiate closed kinetic chain exercises progressing bilateral to unilateral
- Initiate proprioception training
Phase IV – Advanced Strengthening (Weeks 12 to 24):
Weeks 12 to 16:
- Initiate gym strengthening-beginning bilateral progressing to unilateral
- Leg press, heel raises, hamstring curls, squats, lunges, knee extensions (30° to 0° as tolerated).
Weeks 16 to 24:
- Continue with advanced strengthening
- Begin functional cord program
Phase V – Return to Sport/Functional Program (Week 24):
- Follow-up examination with physician
- Implement sport specific multi-directional drills
- Continue with lower extremity strengthening, cardiovascular training, and flexibility
- Sports test for return to play
