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- 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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