Knee Rehabilitation - Physical Therapy Protocols

Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
AUTOLOGOUS CHONDROCYTE IMPLANTATION
(FEMORAL CONDYLE ONLY)
REHABILITATION PROTOCOL
WEIGHT BRACE ROM THERAPEUTIC
BEARING EXERCISE
PHASE I
0-2 weeks: non- 0-2 weeks: locked in
0-4 weeks:
0-2 weeks: Quad sets, SLR,
0 - 12 weeks weight bearing full extension (removed CPM: use in hamstring isometrics - complete
for CPM and exercise) 2 hour in- exercises in brace if quad control
2-4 weeks: partial 2-4 weeks: Gradually crements for is inadequate
weight bearing - open brace 20 at a 6 - 8 hours 2-6 weeks: Begin progressive
(30 - 40 lbs) time as quad control per day at 1 closed chain exercises*
4-6 weeks: is gained - discontinue cycle/minute - 6-10 weeks: Progress bilateral
progress to use use of brace when quads begin at 0-30 closed chain strengthening, begin
of one crutch can control SLR without increasing opened chain knee strengthening
6-12 weeks: an extension lag 5-10 daily per 10-12 weeks: Progress closed
progress to full patient comfort - chain exercises using resistance
weight-bearing patient should less than patient's body weight,
gain at least 90 progress to unilateral closed
by week 4 and chain exercises, begin balance
120-130 by activities
week 6
PHASE II Full with a None Full active Advance bilateral and unilateral
12 weeks - normalized range of closed chain exercises with
6 months gait pattern motion emphasis on concentric/eccentric
control, continue with biking, stairmaster
and treadmill, progress balance activities
PHASE III Full with a None Full and Advance strength training, initiate
6 - 9 months normalized pain-free light plyometrics and jogging - start with
gait pattern 2 minute walk/2 minute jog, emphasize
sport-specific training
PHASE IV Full with a None Full and Continue strength training - emphasize
9 - 18 months normalized pain-free single leg loading, begin a progressive
gait pattern running and agility program - high impact
activities (basketball, tennis, etc.) may
begin at 16 months if pain-free
*Respect chondrocyte graft site with closed chain activities:
If anterior - avoid loading in full extension
If posterior - avoid loading in flexion >45
**If pain or swelling occurs with any activities, they must be modified to decrease symptoms
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
AUTOLOGOUS CHONDROCYTE IMPLANTATION
(TROCHLEA/PATELLA)*
REHABILITATION PROTOCOL
WEIGHT BRACE ROM THERAPEUTIC
BEARING EXERCISE
PHASE I
0-6 weeks: non- 0-2 weeks: locked in 0-4 weeks: 1-4 weeks: Quad sets, SLR,
0 - 12 weeks weight bearing full extension (removed CPM: use in hamstring isometrics - complete
for CPM and exercise) 2 hour in- exercises in brace if quad control
2-4 weeks: Locked crements for is inadequate
at 0 for ambulating 6 - 8 hours 4-10 weeks: begin isometric
per day - begin closed chain exercises - at 6-10
6-8 weeks: 4-6 weeks: Begin to at 0-30 - 1 weeks, may begin weight shifting
advance to open 20 to 30 with cycle/minute - activities with involved leg extended
partial weight bear ambulation - discontinue after week 3, if full weight bearing - at 8 weeks begin
status - progress use after 6 weeks increase balance activities and stationary bike
to use of one flexion by 5 - with light resistance
crutch 10 daily 10-12 weeks: hamstring
8-12 weeks: 6-8 weeks: strengthening, theraband 0-30
progress to full gain 0-90 resistance, light open chain
weight bearing and 8 weeks: knee isometrics
discard crutches gain 0-120
PHASE II Full with a None Full range Begin treadmill walking at a slow
12 weeks - normalized of motion to moderate pace, progress
6 months gait pattern balance/proprioceptive activities,
initiate sport cord lateral drills
PHASE III Full with a None Full and Advance closed chain strengthening,
6 - 9 months normalized pain-free initiate unilateral closed chain exercises,
gait pattern progress to fast walking and backward
walking on treadmill (initiate incline at
8-10 months), initiate light plyometric
activity
PHASE IV Full with a None Full and Continue strength training - emphasize
9 - 18 months normalized pain-free single leg loading, begin a progressive
gait pattern running and agility program - high impact
activities may begin at 16 months
if pain-free
*Most trochlear/patellar defect repairs are performed in combination with a distal realignment procedure, and thus weight bearing
is restricted for the first 4-6 weeks to protect the bony portion of the distal realignment during healing
**May consider patellofemoral taping or stabilizing brace if improper patella tracking stresses implantation
***If pain or swelling occurs with any activities, they must be modified to decrease symptoms
NOTE: Post-operative stiffness in flexion following trochlear/patellar implantation is not uncommon and patients
are encouraged to achieve 90 of flexion at least 3x/day out of the brace after their first post-op visit (day 7-10)
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
ACL RECONSTRUCTION (PATELLA TENDON GRAFT)* WITH
AUTOLOGOUS CHONDROCYTE IMPLANTATION (FEMORAL CONDYLE)
REHABILITATION PROTOCOL
WEIGHT BRACE ROM THERAPEUTIC
BEARING EXERCISES
PHASE I
0-2 weeks: non- 0-2 weeks: locked in
0-4 weeks:
1-2 weeks: active/passive ROM,
0 - 12 weeks weight bearing full extension (removed CPM: use in active knee extension 90-60 ,
for CPM and exercise) 2 hour incre- quad/hamstring sets, SLR, begin
2-4 weeks: partial 2-6 weeks: gradually ments for 6 - active hamstring strengthening
weight bearing open 20 at a time 8 hours per 2-6 weeks: progress exercises in
(30 - 40 lbs) with as patient gains quad day, begin at phase I, add resistance above the knee,
crutches control - discontinue 0-30 , 1 begin closed chain exercises keeping
4-6 weeks: use of brace when cycle/minute - weight bearing restrictions in mind
progress to one patient has good after week 3, 6-10 weeks: weight shifting
crutch quad control, but no increase flexion activities, progress closed chain
6-12 weeks: sooner than 6 weeks by 5-10 daily and hamstring strengthening,
progress to full forward/backward treadmill walking,
weight bearing begin Stairmaster
without crutches 10-12 weeks: progress closed chain
activities using resistance less than
patient's body weight, open chain knee
extension 90-30 , continue hamstring
strengthening, balance activities
PHASE II Full with a None Maintain full Advance closed chain exercises,
12 weeks - normalized active/passive begin full ROM active knee extension*,
6 months gait pattern range progress treadmill - initiate light jog
PHASE III Full with a None Full and Initiate slight incline with treadmill jog,
6 - 12 months normalized pain-free emphasize single leg loading, begin
gait pattern progressive running and agility program-
including sport-specific activities
*Monitor for signs of patella femoral irritation
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
ACL ALLOGRAFT RECONSTRUCTION
REHABILITATION PROTOCOL
WEIGHT BRACE ROM THERAPEUTIC
BEARING EXERCISES
PHASE I As tolerated with
0-2 weeks: locked in
As tolerated Heel slides, quad/hamstring sets,
0 - 2 weeks crutches* full extension for patellar mobs, prone hangs,
ambulation and sleeping gastroc/soleus stretch***,
SLR with brace in full
extension until quad strength
prevents extension lag
PHASE II Discontinue Discontinue use Maintain full Progress to weight bearing
2 - 6 weeks crutch use when patient has full extension and gastroc/soleus stretch, begin toe
extension and no progressive raises, closed chain extension,
extension lag flexion balance exercises, hamstring
curls, and stationary bike
PHASE III Full, without use None Gain full and Advance closed chain
6 weeks - of crutches and pain-free strengthening, progress
4 months with a normalized proprioception activities, begin
gait pattern Stairmaster/Nordic Trac and
running straight ahead at 12 weeks
PHASE IV Full None Full and Progress flexibility/strengthening,
4 - 6 months pain-free progression of function: forward/
backward running, cutting, grapevine,
etc., initiate plyometric program and
sport-specific drills
May add open chain quad exercises
PHASE V Full None Full and Gradual return to sports participation,
6 months pain-free maintenance program for strength
and beyond and endurance
At patient's discression, a
functional ACL brace may be used
from 6 mo to 1 yr post-op
*Modified with concomitantly performed meniscus repair/transplantation or articular cartilage procedure
***This exercise is to be completed in a non-weight bearing position
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
ACL PATELLAR TENDON AUTOGRAFT RECONSTRUCTION
REHABILITATION PROTOCOL
WEIGHT BRACE ROM THERAPEUTIC
BEARING EXERCISES
PHASE I
0 - 4 weeks As tolerated with 0-2 weeks: locked in As tolerated Heel slides, quad/hamstring sets,
crutches* full extension for patellar mobs, prone hangs, gastroc/soleus
ambulation and sleeping stretch***, SLR with brace in full
2-4 weeks: unlocked extension until quad strength
for ambulation, remove prevents extension lag
for sleeping**
PHASE II
4 - 6 weeks Gradually Discontinue use when Maintain full Progress to weight bearing
discontinue patient has full extension and gastroc/soleus stretch, begin toe
crutch use extension and no progressive raises, closed chain extension,
extension lag flexion balance exercises, hamstring
curls, and stationary bike
PHASE III
6 weeks - Full, without use None Gain full and Advance closed chain
4 months of crutches and pain-free strengthening, progress
with a normalized proprioception activities, begin
gait pattern Stairmaster/Nordic Trac and
running straight ahead at 12 weeks
PHASE IV
4 - 6 months Full None Full and Progress flexibility/strengthening,
pain-free progression of function: forward/
backward running, cutting, grapevine,
etc., initiate plyometric program and
sport-specific drills
May add open chain quad exercises
PHASE V
6 months Full None Full and Gradual return to sports participation,
and beyond pain-free maintenance program for strength
and endurance
At patient's discression, a functional
ACL brace may be used for sports
*Modified with concomitantly performed meniscus repair/transplantation or articular cartilage procedure from 6 mo to 1 year post-op
***This exercise is to be completed in a non-weight bearing position
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
ACL HAMSTRING AUTOGRAFT RECONSTRUCTION
REHABILITATION PROTOCOL
WEIGHT BRACE ROM THERAPEUTIC
BEARING EXERCISE
PHASE I As tolerated
0-2 week: locked in
As tolerated Heel slides, quad sets, patellar mobs
0 - 4 weeks with crutches* full extension for gastroc/soleus stretch***, SLR with
ambulation and sleeping brace in full extension until quad
strength prevents extension lag****
PHASE II Gradually Discontinue use when Maintain full Progress to weight bearing
4 - 6 weeks discontinue patient has full extension and gastroc/soleus stretch and closed
crutch use extension and no progressive chain activities, begin hamstring
extension lag flexion stretching
PHASE III Full, without use None Gain full and Begin hamstring strengthening, advance
6 weeks - of crutches and pain-free closed chain strengthening, progress
4 months with a normalized proprioception activities, begin
gait pattern Stairmaster/Nordic Trac, begin running
straight ahead at 12 weeks
PHASE IV Full None Full and Progress flexibility/strengthening,
4 - 6 months pain-free progression of function: forward/
backward running, cutting, grapevine,
etc., initiate plyometric program and
sport-specific drills
PHASE V Full None Full and Gradual return to sports participation,
6 months pain-free maintenance program for strength
and beyond and endurance
At patient's discression, a functional ACL
brace can be used from 6 mo to 1 yr post-op
*Modified with concomitantly performed meniscus repair/transplantation or articular cartilage procedure
**Avoid open chain quadriceps strengthening for first 4 months
***This exercise is to be completed in a non-weight bearing position
****NO hamstring stretching until 4 weeks post-operative
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
HIGH TIBIAL OSTEOTOMY - OPENING WEDGE
REHABILITATION PROTOCOL
WEIGHT BRACE ROM THERAPEUTIC
BEARING EXERCISES**
PHASE I
0-6 Weeks: Non-
Locked in full extension As tolerated - Heel slides 0 - 90 , quad sets,
0 - 6 weeks weight bearing with for all activities (including CPM* for 2 ankle pumps, calf/hamstring
crutches sleeping) - remove for hours, twice stretches***, SLR with brace
exercise and CPM use (if daily, from locked in full extension, resisted
applicable) 0 - 90 of plantarflexion
flexion out of
brace
PHASE II As tolerated with Unlocked for ambulation - Discontinue Progress exercises in phase I,
6 - 8 weeks crutches - begin to removed for sleeping CPM if knee SLR without brace if able to
advance to a flexion is at maintain full extension, initiate
normalized gait least 90 stationary bike with low resistance
pattern without
crutches
PHASE III Full, without use Discontinue use - per Gain full and Mini-squats 0-45 - progressing
8 weeks - of crutches and physician pain-free to step-ups, leg press 0-60 , closed
3 months with a normalized chain terminal knee extensions, toe
gait pattern raises, balance activities, hamstring
curls, increase to moderate resistance
on bike
PHASE IV Full None Full and Progress closed chain activities,
3 - 9 months pain-free begin treadmill walking, swimming, and
sport-specific activities
**No closed chain exercises until 6 weeks post-op
***This exercise is to be completed in a non-weight bearing position
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
ARTHROSCOPIC LATERAL RELEASE
REHABILITATION PROTOCOL
WEIGHT BRACE ROM THERAPEUTIC
BEARING EXERCISES
PHASE I As tolerated with None As tolerated Heel slides, quad/hamstring sets,
0 - 2 weeks crutches patellar mobilization in all quadrants, prone
hangs, gastroc/soleus stretch*,
Straight leg raising, edema control
PHASE II Gradually None Maintain full Progress to normal gait pattern,
2 - 6 weeks discontinue extension and gastroc/soleus stretch, begin toe
crutch use progressive raises, closed chain extension,
flexion balance exercises, hamstring
curls, and stationary bike
PHASE III Full, without use None Gain full and Advance closed chain
6 weeks - of crutches and pain-free strengthening, progress
3 months with a normalized proprioception activities, begin
gait pattern Stairmaster/Nordic Trac and
running straight ahead
PHASE IV Full None Full and Progress flexibility/strengthening,
3 months and pain-free progression of function: forward/
beyond backward running, cutting, grapevine,
etc., initiate plyometric program and
sport-specific drills
Gradual return to sports participation,
maintenance program for strength
and endurance
* This exercise is to be performed in a non-weight bearing position
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
MENISCAL ALLOGRAFT TRANSPLANTATION
REHABILITATION PROTOCOL
WEIGHT BRACE ROM THERAPEUTIC
BEARING EXERCISE**
PHASE I
0-2 weeks: partial 0-1 week: locked in 0-2 weeks: 0-2 weeks: Heel slides, quad sets,
0 - 8 weeks weight bearing - full extension for non-weight patellar mobs, SLR, SAQ
(up to 50%) sleeping* bearing 0-90 2-8 weeks: addition of heel
2-6 weeks: as 0-2 weeks: locked in 2-8 weeks: raises, total gym (closed chain),
tolerated with extension for all as tolerated, and terminal knee extensions -
crutches - weight bearing non-weight activities with brace until 6 weeks,
discontinue use activities bearing then without brace to tolerance
of crutches at 4 2-6 weeks: Locked NOTE: No weight bearing with
weeks when 0 - 90 - discontinue flexion >90 during phase I
gait normalizes brace after 6 weeks
PHASE II Full, without None Full active Progress closed chain activities, begin
8 - 12 weeks crutches range of hamstring work, lunges 0-90 of flexion,
motion proprioception exercises, leg press
0-90 - flexion only, begin stationary bike
PHASE III Full with a None Full and Progress phase II exercises and
12 - 16 weeks normalized pain-free functional activities such as:
gait pattern single leg hops, jogging to running
progression, plyometrics, slideboard,
and sport-specific drills
*Brace may be removed for sleeping after first post-operative visit (day 7-10)
**Avoid any tibial rotation for 8 weeks to protect meniscus
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
MICROFRACTURE - FEMORAL CONDYLE
REHABILITATION PROTOCOL
WEIGHT BRACE ROM THERAPEUTIC
BEARING EXERCISE
PHASE I Touchdown None Use of a CPM for
Passive stretching/exercise
0 - 6 weeks weight bearing 6-8 hours/day - set for the first 6 - 8 weeks, quad/hamstring
(20-30%) for the at a rate of 1 cycle/ isometrics
first 6 weeks. minute, advancing 10
daily - begin at a level
of flexion that is
comfortable for the
patient - advance to
full flexion as tolerated
PHASE II Gradual return None Gain full and Progressive active strengthening
6 - 12 weeks to full weight pain-free
bearing
PHASE III Full None Full and pain-free Return to full activities, including
12 weeks cutting, turning, and jumping
and beyond
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
MICROFRACTURE - TROCHLEAR/PATELLAR DEFECT
REHABILITATION PROTOCOL
WEIGHT BRACE ROM THERAPEUTIC
BEARING EXERCISE
PHASE I Weight bearing Locked 0 - 30 Use of a CPM for
Passive stretching/exercise
0 - 6 weeks as tolerated of flexion for 6-8 hours/day - begin for the first 6 - 8 weeks, quad/hamstring
in brace weight bearing at a rate of 1 cycle/ isometrics
Unlocked when non- minute, ranging from
weight bearing 0 - 50, advance 10
degrees daily - advance
to full flexion as
tolerated
PHASE II Full None Gain full and Begin closed chain activities,
6 - 12 weeks pain-free emphasizing a patellofemoral program
PHASE III Full None Full and pain-free Return to full activities, including
12 weeks cutting, turning, and jumping
and beyond
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
MENISCAL ALLOGRAFT TRANSPLANTATION WITH
AUTOLOGOUS CHONDROCYTE IMPLANTATION
REHABILITATION PROTOCOL
WEIGHT BRACE ROM THERAPEUTIC
BEARING EXERCISE
PHASE I
0-4 weeks: non- 0-2 weeks: locked in
10 days - 4
0-2 weeks: Quad sets, SLR,
0 - 12 weeks weight bearing full extension (removed weeks: CPM - hamstring isometrics - complete
for CPM and exercise) use in 2 hour exercises in brace if quad control
4-6 weeks: partial 2-4 weeks: Gradually increments for is inadequate
weight bearing - open brace 20 at a 6 - 8 hours 2-6 weeks: Begin progressive
(30 - 40 lbs) time as quad control per day- begin closed chain exercises*
is gained - discontinue at 0-40 and 6-10 weeks: Progress bilateral
6-12 weeks: use of brace when increase by closed chain strengthening, begin
progress to full quads can control SLR 5-10 daily, as opened chain knee strengthening
weight bearing without extension lag. tolerated - 10-12 weeks: Progress closed
patient should chain exercises using resistance
gain full ROM less than patient's body weight,
by 12 weeks progress to unilateral closed chain
exercises, begin balance activities
PHASE II Full with a None Full active Advance bilateral and unilateral closed
12 weeks - normalized range of chain exercises with emphasis on
6 months gait pattern motion concentric/eccentric control, continue
with biking, Stairmaster, and treadmill,
progress balance activities
PHASE III Full with a None Full and Advance strength training, initiate
6 - 9 months normalized pain-free light plyometrics and jogging - start with
gait pattern a 2 minute walk/2 minute jog, emphasize
sport-specific training
PHASE IV Full with a None Full and Continue strength training - emphasize
9 - 18 months normalized pain-free single leg loading, begin a progressive
gait pattern running and agility program - high impact
activities (basketball, tennis, etc.) may
begin at 16 months if pain-free
*Respect chondrocyte graft site with closed chain activities:
If anterior - avoid loading in full extension
If posterior - avoid loading in flexion >45
**If pain or swelling occurs with any activities, they must be modified to decrease symptoms
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
MULTI-LIGAMENT RECONSTRUCTION
REHABILITATION PROTOCOL
WEIGHT BRACE ROM THERAPEUTIC
BEARING EXERCISES
PHASE I
0 - 3 weeks Non - weight Locked in full extension None Quad sets, ankle pumps, SLR, hip ab/
bearing adduction, hamstring/calf stretch, calf
press with theraband, patellar mobilization
3 - 6 weeks Non - weight 3 - 6 weeks: locked in full passive only** Add chair slides, passive ROM in prone
bearing extension for ambulation - to tolerance position
removed for exercise 0 to 70 degrees
PHASE II
6 - 12 weeks Weeks 6 - 10: 6-10 weeks: unlocked for Maintain full 6-8 weeks: gait training, wall slides,
Progress 25% per all activities extension and mini-squats, resisted hip exercises in
week until full 10 weeks - 4 mo: Varus progressive standing***
weight bearing at 10 unloader brace flexion 8-12 weeks: stationary bike with light
weeks resistance (to begin) and seat higher
than normal, closed chain terminal knee
extensions, Stairmaster, balance and
propriception activities, leg press (limiting
knee flexion to 90 )
PHASE III
12 weeks - Full, without use Varus unloader brace Gain full and Advance closed chain strengthening,
4 months of crutches and pain-free progress proprioception and balance
with a normalized activities, maintain flexibility
gait pattern
4 mo - 7 mo Full None Full Treadmill walking, advance to jog
Add hamstring curls for strengthening
PHASE IV
7 months Full None Full and Maintain strength, endurance, and
and beyond pain-free function, begin sport-specific functional
progression (backward running, cutting,
grapevine, etc.), progress to running,
initiate a plyometric program
Return to sports with PCL brace until
1 year post-op
**Maintain anterior pressure on proximal tibia as knee is flexed - prevent posterior sagging at all times
***Resistance must be proximal to knee with hip ab/adduction exercises
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
OSTEOCHONDRAL AUTOGRAFT TRANSPLANT
REHABILITATION PROTOCOL
WEIGHT BRACE ROM THERAPEUTIC
BEARING EXERCISE
PHASE I Non-weight
0-1 week: locked in
0-6 weeks: PROM/AAROM to tolerance,
0 - 6 weeks bearing full extension (remove CPM: use for patella and tibiofibular joint mobs
for CPM and exercise) 6-8 hours (grades I & ll), stationary bike for ROM,
2-4 weeks: gradually per day - begin quad, hamstring, adduction, and gluteal
open brace in 20 in- at 0-50 , 1 sets, hamstring stretches, hip
crements as quad control cycle/minute - strengthening, SLR, ankle pumps
is gained - discontinue use increasing
of brace when quads can 5-10 daily per
control SLR without an patient comfort -
extension lag patient should
gain 100 by
week 6
PHASE II Progress to None Gradually Gait training, scar and patellar mobs,
6 - 8 weeks full weight increase flexion- quad/hamstring strengthening, begin
bearing patient should closed chain activities (wall sits, shuttle,
obtain 130 of mini-squats, toe raises), begin unilateral
flexion stance activities
PHASE III Full with a None Full and Advance activities in phase II
8 - 12 weeks normalized pain-free
gait pattern
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
OSTEOCHONDRAL ALLOGRAFT TRANSPLANT
REHABILITATION PROTOCOL
WEIGHT BRACE ROM THERAPEUTIC
BEARING EXERCISE
PHASE I Non-weight
0-1 week: locked in
0-6 weeks: PROM/AAROM to tolerance, patella and
0 - 6 weeks bearing full extension (removed CPM: use for tibiofibular joint mobs (grades I & II),
for CPM and exercises) 6-8 hours per quad, hamstring, and gluteal sets,
2-4 weeks: Gradually day - begin at hamstring stretches, hip strengthening,
open brace in 20 in- at 0-40 - SLR
crements as quad control increasing 5-10
is gained - discontinue use daily per patient
of brace when quads can comfort
control SLR without an patient should
extension lag gain 100 by
week 6
PHASE II Partial weight None Gradually Scar and patellar mobs, quad/hamstring
6 - 8 weeks bearing (25%) increase flexion- strengthening, stationary bike for ROM,
patient should continue to advance lower extremity
have 130 of strengthening activities
flexion
PHASE III Gradually return to None Progress to full Gait training, begin closed chain activities
8 - 12 weeks full weight bearing and pain-free (wall sits, shuttle, mini-squats, toe
raises), begin unilateral stance activities
PHASE IV Full with a None Full and Advance phase III activities
12 weeks - normalized pain-free
6 months gait pattern
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
PATELLAR REALIGNMENT W/ OSTEOTOMY
FOR PATELLAR INSTABILITY - REHABILITATION PROTOCOL
WEIGHT BRACE ROM** THERAPEUTIC
BEARING EXERCISES
PHASE I Non-weight bearing
0 - 2 weeks: Locked in
0 - 2 weeks: Heel slides, quad/hamstring sets,
0 - 6 weeks extension for sleep, 0 - 30 degrees patellar mobilization in all quadrants, prone
ambulation, can 2 - 4 weeks: hangs, gastroc/soleus stretch*,
unlock 0 - 30 degrees 0 - 60 degrees Straight leg raising with brace locked in
2 - 4 weeks: Unlocked 4 - 6 weeks: extension, edema control
0 - 60 degrees 0 - 90 degrees
4 - 6 weeks: Unlocked
0 - 90 degrees
PHASE II 6 - 8 weeks:
6 - 8 weeks: Unlocked
Maintain full Progress to normal gait pattern,
6 - 12 weeks Advance to weight 8 weeks: Discontinue use extension and gastroc/soleus stretch, begin toe
bearing as tolerated progressive raises, closed chain extension,
Discontinue crutches flexion balance exercises, hamstring
as tolerated curls, and stationary bike
PHASE III Full, without use None Gain full and Advance closed chain
3 - 4 months of crutches and pain-free strengthening, progress
with a normalized proprioception activities, begin
gait pattern Stairmaster/Nordic Trac and
running straight ahead
PHASE IV Full None Full and Progress flexibility/strengthening,
4 months and pain-free progression of function: forward/
beyond backward running, cutting, grapevine,
etc., initiate plyometric program and
sport-specific drills
Gradual return to sports participation,
maintenance program for strength
and endurance
* This exercise is to be performed in a non-weight bearing position
** In cases of realignment for patellar cartilage defects, CPM & full motion may be allowed
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
PCL RECONSTRUCTION
REHABILITATION PROTOCOL
WEIGHT BRACE ROM THERAPEUTIC
BEARING EXERCISES
PHASE I
0 - 3 weeks Non - weight Locked in full extension None Quad sets, ankle pumps, SLR, hip ab/
bearing adduction, hamstring/calf stretch, calf
press with theraband, patellar mobilization
3 - 6 weeks Non - weight 3 - 6 weeks: locked in full passive only** Add chair slides, passive ROM in prone
bearing extension for ambulation - to tolerance position
removed for exercise 0 to 70 degrees
PHASE II
6 - 12 weeks Weeks 6 - 10: 6-10 weeks: unlocked for Maintain full 6-8 weeks: gait training, wall slides,
Progress 25% per all activities extension and mini-squats, resisted hip exercises in
week until full 10 weeks: discontinue use progressive standing***
weight bearing at 10 flexion 8-12 weeks: stationary bike with light
weeks resistance (to begin) and seat higher
than normal, closed chain terminal knee
extensions, Stairmaster, balance and
propriception activities, leg press (limiting
knee flexion to 90 ), open chain quad
ranging from 0 - 60 degrees
PHASE III
12 weeks - Full, without use None Gain full and Advance closed chain strengthening,
4 months of crutches and pain-free progress proprioception and balance
with a normalized activities, maintain flexibility
gait pattern
4 mo - 7 mo Full None Full Treadmill walking, advance to jog
Add hamstring curls for strengthening
PHASE IV
7 months Full None Full and Maintain strength, endurance, and
and beyond pain-free function, begin sport-specific functional
progression (backward running, cutting,
grapevine, etc.), progress to running,
initiate a plyometric program
Return to sports in PCL brace until 1 year
post-op
**Maintain anterior pressure on proximal tibia as knee is flexed - prevent posterior sagging at all times
***Resistance must be proximal to knee with hip ab/adduction exercises
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
PCL INJURY - NON-OPERATIVE
REHABILITATION PROTOCOL
WEIGHT BRACE ROM THERAPEUTIC
BEARING EXERCISES
PHASE I
0 - 1 weeks Progress to weight- Locked in full extension Within limits of Isometric quad sets, ankle pumps, SLR,
bearing as tolerated when not in PT pain, in prone hip ab/adduction, hamstring/calf stretch,
with crutches position No open chain hamstrings
2 - 3 weeks WBAT, Brace unlocked for flexion Increase ROM, Add open chain knee extension
can discontinue 15 degree extension stop in prone position
crutches for ambulation
PHASE II
3 - 4 weeks WBAT Fit for PCL brace, 15 Full, begin Add closed chain exercises
degree extension stop active ROM stationary bike with light
resistance (to begin) and seat higher
than normal, closed chain terminal knee
extensions, Stairmaster, balance and
propriception activities, leg press (limiting
knee flexion to 90 ), open chain quad
ranging from 0 - 60 degrees
No open chain hamstrings
PHASE III
5 - 6 weeks Full, without use PCL brace for remainder Gain full and Advance closed chain strengthening,
of crutches and of season, extension stop pain-free progress proprioception and balance
with a normalized at zero activities, maintain flexibility
gait pattern May add hamstring strengthening
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
PCL and PLC RECONSTRUCTION
REHABILITATION PROTOCOL
WEIGHT BRACE ROM THERAPEUTIC
BEARING EXERCISES
PHASE I
0 - 3 weeks Non - weight Locked in full extension None Quad sets, ankle pumps, SLR, hip ab/
bearing adduction, hamstring/calf stretch, calf
press with theraband, patellar mobilization
3 - 6 weeks Non - weight 3 - 6 weeks: locked in full passive only** Add chair slides, passive ROM in prone
bearing extension for ambulation - to tolerance position
removed for exercise 0 to 70 degrees
PHASE II
6 - 12 weeks Weeks 6 - 10: 6-10 weeks: unlocked for Maintain full 6-8 weeks: gait training, wall slides,
Progress 25% per all activities extension and mini-squats, resisted hip exercises in
week until full 10 weeks - 4 mo: Varus progressive standing***
weight bearing at 10 unloader brace flexion 8-12 weeks: stationary bike with light
weeks resistance (to begin) and seat higher
than normal, closed chain terminal knee
extensions, Stairmaster, balance and
propriception activities, leg press (limiting
knee flexion to 90 )
PHASE III
12 weeks - Full, without use Varus unloader brace Gain full and Advance closed chain strengthening,
4 months of crutches and pain-free progress proprioception and balance
with a normalized activities, maintain flexibility
gait pattern
4 mo - 7 mo Full None Full Treadmill walking, advance to jog
Add hamstring curls for strengthening
PHASE IV
7 months Full None Full and Maintain strength, endurance, and
and beyond pain-free function, begin sport-specific functional
progression (backward running, cutting,
grapevine, etc.), progress to running,
initiate a plyometric program
Return to sports with PCL brace until
1 year post-op
**Maintain anterior pressure on proximal tibia as knee is flexed - prevent posterior sagging at all times
***Resistance must be proximal to knee with hip ab/adduction exercises
Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
TIBIAL TUBERCLE OSTEOTOMY
WITH PATELLAR MICROFRACTURE
REHABILITATION PROTOCOL
WEIGHT BRACE ROM** THERAPEUTIC
BEARING EXERCISES
PHASE I Non-weight bearing
0 - 6 weeks: Locked in
0 - 2 weeks: Heel slides, quad/hamstring sets,
0 - 6 weeks extension for sleep, CPM 0-50, patellar mobilization in all quadrants, prone
ambulation, can advance 10 hangs, gastroc/soleus stretch*,
unlock for exercise degrees/day Straight leg raising with brace locked in
to full extension, edema control
PHASE II 6 - 8 weeks:
6 - 8 weeks: Unlocked
Maintain full Progress to normal gait pattern,
6 - 12 weeks Advance to weight 8 weeks: Discontinue use extension and gastroc/soleus stretch, begin toe
bearing as tolerated progressive raises, closed chain extension,
Discontinue crutches flexion balance exercises, hamstring
as tolerated curls, and stationary bike
PHASE III Full, without use None Gain full and Advance closed chain
3 - 4 months of crutches and pain-free strengthening, progress
with a normalized proprioception activities, begin
gait pattern Stairmaster/Nordic Trac and
running straight ahead
PHASE IV Full None Full and Progress flexibility/strengthening,
4 months and pain-free progression of function: forward/
beyond backward running, cutting, grapevine,
etc., initiate plyometric program and
sport-specific drills
Gradual return to sports participation,
maintenance program for strength
and endurance
* This exercise is to be performed in a non-weight bearing position