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

  • Ice and modalities to reduce pain and inflammation
  • Use crutches non-weight bearing for 6 weeks
  • Elevate the knee above the heart for the first 3 to 5 days
  • Initiate patella mobility drills
  • CPM x 6 weeks
  • Full passive/active knee range of motion exercises
  • Quadriceps setting focusing on VMO restoration
  • Multi-plane open kinetic chain straight leg raising
  • Gait training with crutches (NWB)

Phase II – Progressive Stretching and Early Strengthening (Weeks 1 to 6):

  • Patella mobility and scar massage
  • Initiate global lower extremity stretching program
  • Stationary bike and deep water pool exercise program (when incisions healed)
  • Implement reintegration exercises emphasizing core stability
  • Multi-plane ankle strengthening

Phase III – Strengthening and Proprioceptive Phase (Weeks 6 to 12):

  • Begin partial weight bearing at 25% of body weight and increase by 25% approximately 3 days. May progress to one crutch at 7.5 weeks as tolerated, gradually wean off of crutches by week 8 – 9

Weeks 8 to 12:

  • Normalize gait pattern
  • Advance stationary bike program; begin treadmill walking and elliptical trainer; avoid running and impact activity
  • Initiate closed kinetic chain exercises progressing from bilateral to unilateral
  • Initiate proprioception training

Phase IV – Advanced Strengthening and Initiation of Plyometric Drills (Weeks 12 to 20):

  • Initiate gym strengthening-beginning bilateral progressing to unilateral
  • Linear walking
  • Swimming
  • Bike outside light gearing

Phase V – Return to Sport Functional Program (Weeks 20 to 24):

The following progression is designed for athletes desiring to return to impact/running sports. Patients not returning to impact activity are advised to focus primarily on non-impact cardio-vascular exercise.

  • Pool running with progression to dry land
  • Linear drill with gradual progression to lateral and rotational as tolerated
  • Bilateral plyometric activity progressing to unilateral as tolerated
  • Continue with aggressive lower extremity strengthening, cardiovascular training, and flexibility
  • Sports test for return to play – 6 to 9 months

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