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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 – goal
      • Patella mobility
      • 90° – 100° of knee flexion, progressing to full as tolerated
      • 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
    • Full knee extension/hyperextension
    • Knee flexion to 120°, progress as tolerated
  • Exercises
    • Bilateral closed kinetic chain squatting
    • Multi-plane open and closed kinetic chain hip strengthening
    • Step-up progression
    • Stationary biking
    • Pool program when incisions healed; focus on ROM
    • Proprioception drills

Weeks 4 to 6

  • Range of Motion
    • Full knee flexion and extension
  • Exercises
    • Advance strengthening program progressing to unilateral as tolerated
    • Increase intensity of stationary bike program, may add treadmill walking and/or elliptical
    • Advance intensity of pool program; focus on strengthening

Phase III – Advanced Strengthening and Proprioception Phase (Weeks 6 to 12)

Weeks 6 to 12

  • Range of Motion
    • Full knee flexion and extension with terminal stretch
  • Exercises
    • Gym strengthening progressing from bilateral to unilateral as tolerated: Leg press, squats, partial lunges, hamstring curls, ab/adduction, calf raises
    • Multi-directional functional cord work; no rotation or running

Weeks 8 to 12

  • Pool running program

Phase IV – Advance Strengthening and Running progression (Weeks 12 to 16)

Weeks 12 to 16

  • Implement a full gym strengthening program; including leg extensions at 30° – 0°
  • Begin straight plane running
  • Fit functional brace

Phase V – Return to Sport and Functional Drills Phase (Weeks 16 to 24)

Weeks 16 to 20

  • Sprinting
  • Sport specific drills
  • Plyometric drills – bilateral advancing to unilateral as tolerated

Weeks 20 to 24

  • Follow-up examination with the physician
  • Sports test for return to competition at 6 months

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