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

  • Ice and modalities to reduce pain and inflammation
  • Brace 0° to 20° for 6 weeks
  • Use crutches (approx. 2 weeks); wean off as gait normalizes and inflammation subsides
  • Elevate the knee above the heart for the first 3 to 5 days
  • Initiate patella mobility drills
  • CPM x 6 weeks
  • Begin full passive/active knee range of motion exercises
  • Quadriceps setting focusing on VMO restoration
  • Multi-plane open kinetic chain straight leg raising
  • Gait training

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

  • Maintain program as outlined in week 0 to 1
  • Continue with modalities to control inflammation
  • Initiate global lower extremity stretching program
  • Core strengthening program
  • Begin stationary bike and 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):

  • Continue with Phase II exercises as indicated
  • Opening Brace As Follows:
    • 0° to 45° for 3 days
    • 0° to 60° for 3 days
    • 0°to 90° for 3 days
    • Wean out of brace by week 8 – 9
  • Normalize Gait
  • Advance core strengthening program
  • Advance time and intensity on cardiovascular bike program
  • May begin treadmill or elliptical trainer – no running
  • Initiate closed kinetic chain exercises progressing from bilateral to unilateral

Phase IV – Advanced Strengthening (Weeks 12 to 20):

  • Gym-strengthening program avoiding PF provocative exercise (lunges, leg extensions…)
  • Biking outside, walking and swimming

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 running drills with gradual progression to lateral and rotational as tolerated
  • Continue with lower extremity strengthening, cardiovascular training, core and flexibility work
  • Plyometric activity (increasing as tolerated)
  • Sports test for return to play 6 to 9 months

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