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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
    • 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

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