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
