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
- Range of Motion
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
