Phase I – Maximum Protection (Weeks 0 to 6):
0 to 2 Weeks:
- Brace locked at 30° at all times for six weeks
- Ice and modalities to reduce pain and inflammation
- Use crutches non-weight bearing for 6 weeks.
- Range of Motion
- Begin aggressive patella mobility
- ROM 30- 90° WITH VALGUS STRESS APPLIED
- Quadriceps setting, focusing on VMO
- Multi-plane straight leg raising
Weeks 2 to 6:
- Continue with program outlined above
- Range of Motion
- Full knee extension (NO HYPEREXTENSION); limit flexion to 90° until week 4)
Phase II – Progressive Stretching and Early Strengthening (Weeks 2 to 6):
Weeks 6 to 12:
- Continue with modalities to control inflammation
- May begin to progressively increasing weight bearing IN MEDIAL UNLOADER BRACE (to be worn AT ALL TIMES when weight bearing)
- Range of Motion
- Full knee extension (no hyperextension)
- Knee flexion to 120°, progress as tolerated
- Exercises
- Continue with phase I exercise
- Bilateral closed kinetic chain squatting
- Multi-plane open and closed kinetic chain hip strengthening
- Step-up progression
- Stationary biking
- Pool program; focus on ROM
- Proprioception drills
Weeks 12 to 16:
- 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
- Advance intensity of pool program; focus on strengthening.
Phase III – Advanced Strengthening and Proprioception Phase (Weeks 6 to 12):
Weeks 16 to 20:
- Range of Motion
- Full knee flexion and extension with terminal stretch
- Exercises
- Advance cardiovascular program; no running
- Increase intensity of closed kinetic chain exercises
- Advance proprioception drills
- Initiate gym strengthening progressing from bilateral to unilateral as tolerated
- Leg press, squats, partial lunges, hamstring curls, ab/adduction, calf raises
- Increase intensity of bike and walking program, may add elliptical trainer
Weeks 16 to 20:
- May begin a pool running program
Phase IV – Advance Strengthening and Plyometric Drill Phase (Weeks 20 to 24):
Weeks 20 to 24:
- Implement a full gym strengthening program; including leg extensions at 30° – 0°, progressing to full range as PF arthrokinematics normalize
- Begin straight plane running
- Begin controlled lateral functional cord drills
Phase V – Return to Sport and Functional Drills Phase (Weeks 24 to 32):
Weeks 24 to 28
- Continue with aggressive lower extremity strengthening, cardiovascular training, and flexibility
- Implement multidirectional agility drills
- Begin plyometric drills from bilateral to unilateral as tolerated
Weeks 28 to 32:
- Follow-up examination with the physician
- Brace fitting for functional knee brace
- Sports test for return to competition
