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Phase I – Maximum Protection (0 to 2 weeks):

Weeks 0 to 2:

  • Lateral buttress in post-op dressing to stabilize patella
  • Ice and modalities to reduce pain and inflammation
  • Use crutches for 5 to 7 days to reduce swelling. The patient may discontinue the crutches when they can walk without pain and without limping.
  • Elevate the knee above the heart for the first 3 to 5 days
  • Initiate patella mobility exercises in all planes, emphasis on lateral tilt
  • Begin full passive/active knee range of motion
  • Quadriceps setting
  • Multi-plane open chain straight leg raising
  • Gait training

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

Weeks 2 to 6:

  • Maintain program as per week 0 to 2
  • Continue with patella mobility exercises
  • Continue with modalities to help control inflammation
  • Initiate global lower extremity stretching
  • Begin stationary bike, treadmill, and/or elliptical trainer as strength and swelling allow, avoiding impact activity
  • Begin bilateral closed kinetic chain strengthening progressing to unilateral as tolerated
  • Promote normal arthrokinematics with all closed chain exercises
  • Implement reintegration exercises emphasizing core stability
  • Begin closed chain multi-plane hip strengthening
  • Manual lower extremity PNF patterns
  • Proprioceptive drills emphasizing neuromuscular control

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

Weeks 6 to 10:

  • Modalities as needed
  • Continue with phase II exercises as indicated
  • Advance time and intensity on cardiovascular program – no running
  • Begin functional cord resistance program
  • Initiate gym strengthening- bilateral progressing to unilateral as tolerated
  • Leg press, squats, lunges (protected range) hamstring curls, ab/adduction, calf raises
  • Begin pool running program at weeks 8 to 10

Phase IV – Advanced Strengthening and Early Plyometric Drills (10-12 weeks):

Weeks 10 to12:

  • Begin running program at week 10 to 12, this is based on quadriceps function, strength, swelling, and endurance
  • Begin light bilateral plyometric drills

Phase V – Return to Sport Functional Program (weeks 12 to 16):

Weeks 12 to 16:

  • Follow-up examination with physician
  • Implement sport specific multi-directional drills
  • Continue with aggressive lower extremity strengthening, cardiovascular training, and flexibility
  • Progress plyometric exercises to unilateral as tolerated
  • Sports test for return to sport

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