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Phase I – Maximum Protection (Weeks 0 to 6):

0 to 2 weeks:

  • Brace locked in full extension for 6 weeks
  • Partial weight bearing for 2 weeks
  • Ice and modalities to reduce pain and inflammation
  • Aggressive patella mobility drills
  • Gradual progression to full flexion and extension
  • Begin submaximal quadriceps setting, focusing on VMO function
  • Begin multi-plane open kinetic chain straight leg raising program

Weeks 2 to 4:

  • Weight bearing as tolerated; progressing off of crutches
  • Continue with inflammation control
  • Continue with aggressive patella mobility
  • Full range of motion
  • Continue with quadriceps setting and multi-plane straight leg raising
  • Begin low resistance stationary biking
  • Begin pool program when incisions healed, focusing on ROM

Weeks 4 to 6:

  • Full weight bearing
  • Continue with ice and aggressive patella mobility
  • Increase resistance with straight leg raising program
  • Advance pool program to include light resistance work

Phase II – Progressive Range of Motion and Early Strengthening (Weeks 6 to 12):

Weeks 6 to 8:

  • Full weight bearing
  • Open brace to 45°- 60° of flexion week 6, 90° at week 7
  • Continue with swelling control and patella mobility
  • Normalize gait pattern
  • Continue with multi-plane straight leg raising
  • Initiate open kinetic chain progressing to closed kinetic chain multi-plane hip strengthening
  • Begin closed kinetic chain strengthening program focusing on quality VMO function
  • Advance intensity on stationary bike
  • Initiate proprioception drills
  • Begin treadmill walking program and/or elliptical trainer as tolerated

Weeks 8 to 10:

  • Wean out of brace
  • Continue with patella mobility drills
  • Normalize gait pattern
  • Progress open and closed kinetic chain program
  • Increase intensity of cardiovascular program

Weeks 10 to 12:

  • Full ROM
  • Aggressive terminal quadriceps stretching
  • Advance open and closed kinetic chain strengthening
  • Advance proprioception drills

Phase III – Progressive Strengthening (Weeks 12 to 16):

Weeks 12 to 16:

  • Advance open and closed kinetic chain strengthening
  • Increase intensity on bike, treadmill, and elliptical trainer
  • Increase difficulty and intensity on proprioception drills
  • Begin gym strengthening: leg press, hamstring curls, ab/adduction; avoid lunges and knee extensions
  • Begin multi-directional functional cord program
  • Begin pool running program

Phase IV – Advanced Strengthening and Functional Drills (Weeks 16 to 20):

Weeks 16 to 20:

  • May begin leg extensions; 30° to 0° progressing to full ROM as patellofemoral arthrokinematics normalize
  • Advance pool running program advancing to land as tolerated

Phase V – Plyometric Drills and Return to Sport Phase (Weeks 20 to 24):

Weeks 20 to 24:

  • Advance gym strengthening program
  • Progress running/sprinting program
  • Begin multi-directional field/court drills
  • Begin bilateral progressing to unilateral plyometric drills
  • Follow-up appointment with physician
  • Sports test for return to competition

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