Immediate Postoperative Phase (0-7 days after surgery):
- Wait until your first physical therapy visit for the therapist to change the dressing for you.
- Perform sponge baths or shower with saran wrap covering surgical site.
- If you experience malaise, fever, or chills - contact your physician immediately.
- Perform home exercise program issued at pre-op from Hamilton Orthopaedics Physical Therapy Department.
- Control acute inflammation with the use of cryo cuff or ice 15-20 minutes hourly, rest, elevation, prescribed medications.
- Start Physical Therapy 5 days after surgery.
- Ambulation: weight bearing as tolerated with use of bilateral axillary crutches and postoperative brace locked in extension until first PT appointment. At that time it will be opened 0-30 degrees provided patient is able to perform quad set and straight leg raise independently.
- Therapeutic exercise to include ankle pumps, calf and hamstring flexibility, quad sets, active TKE, SLR flexion and abduction and heel slides.
- Precautions: Low intensity quad strengthening for 3 weeks. No active hamstrings or adduction for 4 weeks and no resisted hamstrings or adduction for 6 weeks .
- No knee flexion beyond 30 degrees.
- Decrease swelling.
- Initiate quad set.
- Independent ambulation with bilateral axillary crutches.
- ROM 0 to 30 degrees.
Phase II (8 days -2 Weeks):
- Open brace to accommodate comfortable ROM to no greater than 50 degrees.
- Wall slides, seated knee flexion, heel slides within range of motion restrictions.
- Quad sets, active TKE open chain, flexibility calf and hamstrings.
- SLR hip flexion and abduction.
- Remain WBAT on bilateral axillary crutches.
- Weight shifting progress to single leg stance.
- Wall squats to 30 degrees.
- TKE in standing.
Sub Acute Phase (2-4 Weeks):Open brace no greater than 20 degrees per week for a total of 90 degrees at 4 weeks post op.
- Isometric knee extension 45 degrees.
- Continue ROM exercises.
- Continue submaximal quad strengthening.
- Step- ups.
- Leg Press (0-60 degrees).
- Gait skills on treadmill.
- Balance and proprioception drills.
Strengthening Phase (4-8 Weeks):
- Progress flexion range of motion to full as tolerated.
- Progress to AROM hamstrings 4 weeks.
- Resisted hamstrings at 6 weeks.
- Squat rack at 60 degrees knee flexion.
- Stationary bike (If 110 degrees of flexion is comfortable).
- Stair climber to tolerance.
- Continue closed chain quad strengthening to tolerance.
- Open chain quads at 4 weeks post-op, 90 – 45 degrees.
- Balance and proprioception single leg drills to tolerance.
- Dynamic flexibility at 6 weeks .
- Discontinue brace at 6 weeks .
Advanced Phase (8-12 Weeks):
- Continue strengthening and proprioception.
- Progress to low level double leg plyometrics uniplanar .
- Interval jogging program.
- Low level agility exercise.
Return to Activity Phase (12-16 weeks):
- Double leg plyometrics multiplanar.
- Single leg plyometrics uniplanar.
- Advanced agility and running.
- Return to Sport at 4 months with physician approval.