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Phase I – Maximum Protection (Weeks 0 to 2)

  • Brace – six weeks
  • Use crutches weight bearing as tolerated for 7 to 10 days to reduce swelling. The patient may discontinue the crutches when they can ambulate with no limp
    • Range of Motion
      • Patella mobility
      • Emphasize full extension (avoid hyperextension x 4-6 weeks)
      • Progress to full flexion as tolerated
    • Exercises
      • Quadriceps setting, focusing on VMO
      • Multi-plane straight leg raising
      • Gait training

Phase II – Progressive Stretching and Early Strengthening (Weeks 2 to 6)

Weeks 2 to 4

  • Range of Motion
    • Patella mobility and scar massage
    • Full knee extension
    • Knee flexion to progressing
  • Exercises
    • Bilateral closed kinetic chain squatting
    • Multi-plane open and closed kinetic chain hip strengthening
    • Step-up progression
    • Stationary biking
    • Pool program: deep water cycling and straight leg flutter kicks, shallow water walking
    • Proprioception drills

Weeks 4 to 6

  • Exercises
    • Advance strengthening program progressing to unilateral as tolerated
    • Increase intensity of stationary bike program, may add treadmill walking and/or elliptical

Phase III – Advanced Strengthening and Proprioception Phase (Weeks 6 to 10)

Weeks 6 to 10

  • Range of Motion
    • Full knee flexion and hyper-extension with terminal stretch (active and passive)
  • Exercises
    • Advance intensity of cardiovascular program; no running
    • Increase intensity of closed kinetic chain exercises
    • Advance proprioception drills
    • Gym program – no extensions
    • Begin lateral functional cord work; no rotation
    • Pool running program at week 8

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