Acute Phase (0-2 weeks)
Goals:
- Active quadriceps muscle contraction.
- Sufficient quadriceps control to allow safe independent ambulation.
- Passive knee extension to 0 degrees.
- Knee flexion to 90 degrees or greater.
- Control of swelling.
Day 1 until hospital discharge:
- Weight bearing as tolerated with walker / 2 crutches .
- Elevation for edema control.
- Cryo-therapy 20 minutes of every hour for edema and pain control.
- Incision covered with Aquacel bandage. Patients may shower normally with the Aquacel bandage in place.
- Gait training: continue safe ambulation for 50 feet, instruct in transfers and stairs prior to discharge.
Home exercises to include:
- Ankle pumps with leg elevation.
- Quad sets.
- Knee extension with patient generated overpressure.
- Gentle knee flexion stretches (i.e. heel slides).
Outpatient physical therapy should be scheduled prior to surgery. Patients may do home PT or rehabilitation if medically necessary and physician ordered.
Days 3 to 14:
- Begin outpatient physical therapy at approximately 3 days post-op.
- Change Aquacel bandage at 1 week post-op unless excessive drainage is evident within the bandage in which case it should be changed sooner.Staple removal at 14 days post-op by PT at which time shower normally without a bandage covering the incision. No submersion until follow up with surgeon at approximately 4 weeks post-op.
- Gait training with appropriate assistive device.
- Continue elevation and cryo-therapy for edema and pain control.
- Tensogrip stocking for edema control.
- Perform home exercise program (HEP) as issued by P.T.
- Instruct in all appropriate transfers for independence in home.
Exercises to include:
- Ankle pumps with leg elevation.
- Quad sets.
- Knee extension with patient generated overpressure.
- Stretch hamstrings, gastroc-soleus.
- Active assistive range of motion knee flexion: i.e wall slides, seated knee flexion.
- Active terminal knee extension with bolster.
- Straight leg raises (flexion, extension, abduction).
- AROM knee extension exercises, long and short arc quads.
- AROM knee flexion exercises.
- Terminal knee extension (biodex, theraband, seated).
- Mini squats to ¼ depth.
- Gait and balance.
Sub-Acute Phase (Weeks 2-6):
Goals:
- Full range of motion 0-120 degrees.
- Enhance muscular strength/endurance.
- Minimize swelling / inflammation.
- Return to functional activities.
Weeks 2-4
- Continue cryo-therapy, compression, and elevation for edema and pain control.
- Continue gait training. Wean from assistive device as able to safely without limp.
Exercises to include:
- Continue all exercises listed previously.
- Knee RROM extension exercises 90-0 degrees (long arc quads).
- Resisted hamstring curls.
- Bicycle for range of motion, may progress to a program per tolerance.
- Step ups forward and lateral.
- Wall squats 45 degrees knee flexion, progress to tolerance.
- Seated leg press machine.
- Progress balance and proprioception .
Weeks 4-6
- Continue all exercises listed previously with appropriate progressions.
- Progress to Nautilus type equipment for resisted knee extension and hamstring curls.
- Initiate progressive return to ADL’s and walking.
- Pool program participation, if available.
Final Phase (Weeks 7-12)
Goals:
- Progression of range of motion, 0-120 degrees and greater.
- Maximize strength, proprioception, and endurance.
- Cardiovascular fitness.
- Functional activity performance.
Exercises to include:
- Continue all exercises listed previously.
- Continue to progress walking program.
- Continue pool program participation.
- Return to all gym programing.
- Progress all recreation and sporting activity to pre-surgical levels per MD clearance.
- Running and high impact activity are not allowed.
- When ROM, strength, gait, balance, and endurance are acceptable, patient may be placed on HEP.
