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.

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