This protocol is intended to be a general outline only. The physician reserves the right to either advance or delay this protocol as deemed necessary. If so, this should be done by direct communication with the therapist, or in writing on the therapy referral form given to the patient on the day of surgery.
Guidelines for Crutches and TROM Brace
- Bilateral axillary crutches to be used immediately post-op, WBAT unless otherwise specified. Patient will gradually reduce use of crutches once able to perform SLR independently.
- TROM brace usage:
- To be fitted at 1st post-op visit and worn with all ADL’s for first 2-4 weeks, initially locked at 0o extension for all weight-bearing activities.
- To be removed only for sleeping, bathing, and exercises.
- Unlock brace for ambulation when able to perform good quad set and independent SLR.
- Discharge TROM for everyday use when patient has normal gait pattern, can perform SLR without quad lag, and maintains 0o knee extension at rest – usually within first four weeks.
- Continue use of TROM for first 8-10 weeks when on unstable surfaces or in large crowds, or when on feet for extended period of time.
- Achieve full ROM by 8-10 weeks post-op
- Avoid hyperextension of knee
- No deep squats or lunges past 45 degrees of knee flexion until 16 weeks post-op
- No running until 4 months post-op
- No torsion or cutting drills till 6 months post-op
- No sports till 8 months post-op
Guidelines for Wound Care
- Place occlusive dressing over steri-strips at wound sites at first visit. Change occlusive dressing every other day, leaving steri-strips on unless they come off easily. Cover old steri-strips with new ones if needed.
- Keep wound sites covered with occlusive dressing until stitches are removed. After that, cover with standard adhesive bandages until wounds are fully healed (wrap knee in plastic wrap for showers).
Frequency of Physical Therapy Visits
Schedule physical therapy visits 3x/week for the first four weeks, or until full passive ROM flexion and extension is achieved and there is no quad lag with SLR. Then decrease to 2x/week until about 8 weeks post-op, at which time the patient may be seen 1x/week or once every other week as appropriate based on patient status and compliance with HEP.
Day 1 Post-Op
- Remove bulky dressings. Leave steri-strips on; place occlusive dressing over all portals and incisions.
- Discard post-op immobilizer. Issue TROM brace (adjusted to fit patient at pre-op visit).
- Begin PROM knee flexion
- Begin PROM