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
