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.

Weeks 0 – 6 Post-Op

General Guidelines
Patient seen 1-2x/week as needed.
Precautions: Patient is NWB during this period.
Goals: Decrease pain, allow healing, PROM to 110 degrees

  • NWB’ing with T-ROM brace locked in extension

  • T-ROM can be removed for ROM / physical therapy sessions

  • CPM to begin Post-Op Day One: 0-45 degrees for 2 hrs BID or TID.

  • CPM can be increased 5-10 degrees per day as tolerated by patient.

  • Open-chain quad exercises (SLR’s, quad sets, etc.)

  • Open-chain hip strengthening

  • If warranted, provide patient with home e-stim unit to be used while doing quad sets.

  • Patellar joint mobs, hamstring stretching, open-chain ankle strengthening

Weeks 6 – 8: Patient seen 2-3x/week
Goals: Full ROM, progress to PWB (50%)

  • Continue above exercises

  • Continue T-ROM in extension for gait

  • Increase PROM to achieve full flexion

  • Stationary bike for ROM

Weeks 8 – 12: Patient seen 2-3x/week
Goals by Week 12: FWB, full pain free ROM

  • Continue above exercises

  • Progress to full pain-free ROM

  • Gait training

  • Begin closed-chain strengthening activities (calf raises, mini-squats, lateral lunges, etc.), starting at <30 degrees flexion and gradually increasing depth with good form

  • Focus on core strength and knee joint control in closed-chain positions

  • Begin single leg stance balance activities

  • Discontinue T-ROM when quad control is sufficient for stable closed-chain control of knee extension

  • Begin Proprio Machine training

Weeks 12 – 16: Patient seen 1-2x/week
Goals: Progress strength, normalize gait.

  • Continue appropriate previous exercises

  • Achieve normal gait pattern

  • Full pain free ROM

  • Advance both open and closed-chain strength exercises as tolerated.

  • Progress to full biking, elliptical machine

Weeks 16 and beyond: Patient seen as needed

Goals: Return to sport and full function.

  • Begin lateral plyo shuffles

  • Perform Proprio Test

  • At 20 weeks: begin jogging and then progress to running drills if patient has good control and endurance with above exercises

  • Progress to bilateral and unilateral hopping drills

  • Begin sport-specific drills

Return to Sport Guidelines

Running:  Begin independent jogging at 4 months post-op, increasing