Phase I – Maximum Protection (0 to 6 weeks):
Weeks 0 to 2:
- Brace locked at 0 degrees x 6 weeks
- Lateral buttress in post-op dressing to stabilize patella
- Ice and modalities to reduce pain and inflammation
- Use crutches for 7-10 days to reduce swelling. The patient may discontinue the crutches when they can walk without pain and without limping.
- Quadriceps setting
- Multi-plane open chain straight leg raising
- Gait training
- NO Patella Mobility x 6 weeks
- ROM 0-30 degrees
Weeks 2 to 4:
- Continue with brace locked at 0 degrees
- Maintain program as per week 0 to 2
- Increase ROM 0-60 degrees
Weeks 4 to 6:
- Continue with brace locked at 0 degrees
- Maintain program as per week 0 to 2
- Increase ROM 0-90 degrees
- Begin closed chain multi-plane hip strengthening
- Implement reintegration exercises emphasizing core stability
Phase II – Progressive Stretching and Early Strengthening (6 to 12 weeks):
Weeks 6 to 8:
- Maintain program as per week 0 to 2
- Opening Brace As Follows:
- to 45° for 3 days
- to 60° for 3 days
- to 90° for 3 days
- Wean out of brace by week 8 – 9
- Avoid Medial/Lateral patella mobility exercises
- Initiate global lower extremity stretching
- Begin stationary bike
Weeks 8-12:
- Begin bilateral closed kinetic chain strengthening progressing to unilateral as tolerated
- Proprioceptive drills emphasizing neuromuscular control
- Elliptical trainer as tolerated
- Aquatic therapy program
Phase III – Advanced Strengthening and Proprioception Phase (12 to 16 weeks):
Weeks 12 to 16:
- Continue with phase II exercises as indicated
- Advance time and intensity on cardiovascular program – no running
- Initiate gym strengthening- bilateral progressing to unilateral as tolerated
- Leg press, squats, lunges (protected range) hamstring curls, ab/adduction, calf raises
Phase IV – Advanced Strengthening and Early Plyometric Drills (16-24 weeks):
Weeks 16-24:
- Initiate pool running 4 wks
- At 5 month begin dry land running program based on quadriceps function, strength, swelling, and endurance
Phase V – Return to Sport Functional Program (week 24):
Week 24:
- Follow-up examination with physician
- Implement sport specific multi-directional drills
- Continue with progressive lower extremity strengthening, cardiovascular training, and flexibility.
- Sports test for return to sport
