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.
  • Lunges.
  • 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.