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Phase I – Maximum Protection (Week 0 to 1):

  • Ice and modalities as needed to reduce pain and inflammation
  • Use crutches for 2 to 5 days to help reduce swelling, the patient may discontinue crutches when able to walk without a limp or pain
  • Elevate the knee above the heart for the first three to five days
  • Initiate patella mobility drills
  • Full active/passive knee range of motion exercises
  • Quadriceps setting focusing on VMO function
  • Multi-plane open kinetic chain straight leg raising
  • Gait training
  • Stationary bike as swelling and pain allow

Phase II – Progressive Stretching and Early Strengthening Phase (Weeks 1 to 4):

  • Patella mobility and scar massage
  • Active and static lower extremity stretching
  • Treadmill and/or elliptical trainer as strength and swelling allow, avoid impact activities
  • Bilateral closed kinetic chain strengthening progressing to unilateral as tolerated
  • Implement reintegration exercises emphasizing core stability exercises
  • Closed kinetic chain multi-plane hip exercises
  • Proprioception drills emphasizing neuromuscular control

Phase III – Advanced Strengthening and Proprioception Phase (Weeks 4 to 6):

  • Advance time and intensity on cardiovascular program-no running
  • Functional cord resistance program
  • Gym program
  • Pool running program progressing to dry land as tolerated

Phase IV – Advanced Strengthening Phase (Weeks 6 to 8):

  • Running and agility program
  • Controlled field drills
  • Advance gym program
  • Plyometric exercises

Phase V – Return to Sports Phase (8-12 weeks):

  • Progress sport specific multi-directional drills
  • > 90% on Sports test and negative clinical exam for return to full activity

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