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.

Assistive Device Usage: Bilateral axillary crutches to be used immediately post-op, NWB (6 weeks) TTWB (6-8 weeks) FWBAT (8 week) unless otherwise specified.


TROM brace usage: To be refitted at 1st post-op visit. Patient will be fitted in the OR following procedure. It is to be worn with all ADL’s and PT exercises for first 8 weeks, initially locked at 0 degrees extension. TROM remains on with sleeping and bathing.

Guidelines for Wound Care: Place occlusive dressing over steri-strips at wound sites at first visit. Change occlusive dressing every day, leaving steri-strips on unless they come off easily. Cover old steri-strips with new ones if needed. Keep wound sites covered with an 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, then decrease to 2x/week as indicated for a total of ~6 months, tapering as appropriate.

Week 0-2

● Therapy should begin on Day One Post Op.
● Ankle pumps every hour
● Post -op brace to maintain full extension and prevent any valgus stress to knee.

● Quad sets & SLR (Brace on) with no lag
● NWB with crutches, TROM locked in extension
● Ice packs or Cryocuff unit on knee for 20-30 minutes every hour, tapering to 3x/day as
swelling decreases
● Passive ROM exercises: Limited to 0 – 30 degrees.
● NO Hip adductor strengthening

Week 3-4 (ROM 0-90 degrees, NWB)
● Supervised PT 2- 3 times a week (may need to adjust based on insurance)
● Continue SLR's in brace with foot straight up, quad isometric sets, ankle pumps
● No weight bearing with knee in flexed position, NWB with brace locked in full extension
● Patellar mobilization exercises
● Brace locked in full extension for ambulation and sleeping, and may unlock for sitting
with limit of 0 – 90 degrees
● May NOT remove brace for HEP
● NO Hip adductor strengthening

Week 5 (ROM 0-125, TTWB)
● Continue with above exercises/ice treatments
● Advance ROM as tolerated with no limits with brace on
● Stationary bike for range of motion (short crank or high seat, no resistance) OK to
remove brace for bike
● No weight bearing with knee in flexed position. Begin TTWB with brace locked in full
● Perform scar massage aggressively
● Progressive SLR program for quad strength with brace on – start with 1 lb, progress 1 -2
lbs per week
● Hamstring and hip PREs
● Seated knee extension (90 to 40 degrees) against gravity with no weight
● NO side lying Hip adductor strengthening</