This protocol is intended to be a general guideline. The physician staff may advance, delay, or alter this protocol based on individual patient status. If so, this should be done by direct communication with the therapist, or in writing on the therapy referral form pro-vided to the patient or therapist.

The therapist should check with physician staff re: co-morbidities that may affect protocol progression, such as meniscal tears, chondral defects, or bone bruise.

Guidelines for Pre-Op Physical Therapy

  • Patient will receive instruction from Dr. Chams or one of his physician extenders on post-operative expectations, post-op Day One exercises, and use of crutches or an-other assistive device. If deemed necessary at that time, the patient may be referred for one pre-op PT visit to receive gait training, review post-op exercises, and discuss post-op expectations.
  • If seen pre-op in PT clinic, patient should be instructed in edema control and post-op exercises (quad set, SLR, ankle pumps) and the importance of resting knee in full knee ext to avoid flexion contracture.

Guidelines for Post-Op Physical Therapy Visits

  • Therapy begins on Day One post-op in the outpatient clinic.
  • Patient is typically seen in clinic 3x/week for the first 4 weeks, or until full extension and functional flexion is achieved AND there is no antalgia or quad lag with SLR.
  • Then decrease to 2x/week until about 8 weeks post-op, at which time patient may be seen 1x/week or every other week as appropriate based on patient status and HEP compliance.

Guidelines for MD Follow-Up Visits (including telehealth)

  • At two weeks post-op, patient will be seen in clinic for removal of stitches and follow up.
  • At six weeks post-op, patient may be seen by physician extender through telehealth video communication during an in-clinic PT session to connect with patient and treat-ing therapist and discuss current ROM and strength status.
  • Additional follow-ups with MD staff will be scheduled as needed.

Guidelines for Wound Care

  • Original steri-strips should be left in place until stitch removal. They can be reinforced with more steri-strips if needed.
  • On Day One post-op, remove bulky post-op cotton and gauze dressings. Place 2×2 gauze pads and occlusive dressing over wound sites. Change dressings as needed and do not allow wounds to become wet.
  • Instruct patient to wrap knee in “press and seal” plastic wrap for showering until 3-5 days after stitches are removed (make sure wounds are fully healed before being ex-posed to water).

Guidelines for Ambulation and Hinged Knee Brace

  • Unless otherwise specified, patient will be TTWB immediately post-op. When quad control allows, progress to WBAT.
  • Hinged (TROM) knee brace will be issued at surgical center. Brace should be ad-ju