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General Rehab considerations for Physical Therapist:
  • Progression should be based on clinical progress, and times given below are approximate.
  • Patients are full weight bearing with crutches, a walker or a cane to assist walking until they are able to demonstrate good walking mechanics
  • Early emphasis is on full extension equal to the opposite leg as soon as possible
  • No passive or active flexion range of motion greater than 90 degrees until staples are removed
  • Regular manual treatment should be conducted to the patella and all incisions so they remain mobile
  • Early exercises should focus on recruitment of the vastus medialis obliquus (VMO)
  • No resisted leg extension machines (isotonic or isokinetic) at any point in the rehab process
  • CPM (continuous passive motion machine) may be issued based upon doctor’s recommendation per case

Timeline for rehabilitation

  • Week 1:
    • Doctor visit after hospital discharge to change dressing and review home exercise program
    • Icing, elevation, and aggressive edema control (i.e. circumferential massage, compressive wraps)
    • Straight leg raise exercises (standing and seated), passive and active ROM exercises
    • Initiate quadricep/adduction/gluteal sets, gait training, balance/proprioception exercises
    • Well leg cycling and upper body conditioning
    • Soft tissue treatments and gentle mobilization to the posterior musculature, patella, and incisions to avoid flexion or patella contracture
  • Week 2-4:
    • Doctor visit at 14 days for staple removal and check-up
    • Continue with home program, progress flexion range of motion, gait training, soft tissue treatments, and balance/proprioception exercises
    • Incorporate functional exercises as able (i.e. seated/standing marching, , hamstring carpet drags, hip/gluteal exercises, and core stabilization exercises)
    • Aerobic exercise as tolerated (i.e. bilateral stationary cycling as able, UBE, pool workouts.)
  • Week 4-6:
    • Doctor visit at 4 weeks post-op
    • Increase the intensity of functional exercises (i.e. progress to walking outside, introducing weight machines as able)
    • Continue balance/proprioception exercises (i.e. heel-to-toe walking, assisted single leg balance)
    • Slow to normal walking without a limp
  • Week 6-8:
    • Add lateral training exercises (i.e. lateral steps, lateral step-ups, step overs) as able.
    • Incorporate single leg exercises as able (eccentric focus early on)
    • Patients should be walking without a limp and range of motion should be < 10 degrees extension and > 110

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