14434124 cartilage doc knee rehabilitation protocols

8/14/2019 14434124 Cartilage Doc Knee Rehabilitation Protocols

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ACL PATELLAR TENDON ALLOGRAFT/AUTOGRAFT RECONSTRUCTION REHABILITATION PROTOCOLWEIGHT BEARING PHASE I0 - 4 weeksAs tolerated with crutches*

BRACE

ROM

THERAPEUTIC EXERCISESHeel slides, quad/hamstring sets, patellar mobs, gastroc/soleus stretch***, SLRwith brace in full extension until quad strength prevents extension lag

0-1 week: locked in full extension for ambulation and sleeping 1-4 weeks: unlockedfor ambulation, remove for sleeping**

As tolerated

PHASE II4 - 6 weeks

Gradually discontinue crutch use

Discontinue use when patient has full extension and no extension lag

Maintain full extension and progressive flexion

Progress to weight bearing gastroc/soleus stretch, begin toe raises, closed chainextension, balance exercises, hamstring curls, and stationary bike

PHASE III6 weeks 4 months

Full, without use of crutches and with a normalized gait pattern

None

Gain full and pain-free

Advance closed chain strengthening, progress proprioception activities, beginStairmaster/Nordic Trac and running straight ahead at 12 weeks

PHASE IV4 - 6 months

Full

None

Full and pain-free

Progress flexibility/strengthening, progression of function: forward/ backwardrunning, cutting, grapevine, etc., initiate plyometric program and sport-specificdrills

PHASE V6 months and beyond


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Full

None

Full and pain-free

Gradual return to sports participation, maintenance program for strength andendurance

*Modified with concomitantly performed meniscus repair/transplantation orarticular cartilage procedure **Brace may be removed for sleeping after firstpost-operative visit (day 7-10) ***This exercise is to be completed in a non-weight bearing position

COPYRIGHT 2003 CRC BRIAN J. COLE, MD, MBA


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ACL PATELLAR TENDON AUTOGRAFT RECONSTRUCTION REHABILITATION PROTOCOL

WEIGHT BEARING PHASE I0 - 4 weeksAs tolerated with crutches*

BRACE

ROM

THERAPEUTIC EXERCISESHeel slides, quad/hamstring sets, patellar mobs, gastroc/soleus stretch***, SLRwith brace in full extension until quad strength prevents extension lag


As tolerated

PHASE II4 - 6 weeks




Progress to weight bearing gastroc/soleus stretch, begin toe raises, closed chainextension, balance exercises, hamstring curls, and stationary bike



None


Advance closed chain strengthening, progress proprioception activities, beginStairmaster/Nordic Trac and running straight ahead at 12 weeks


Full

None

Full and pain-free




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ACL RECONSTRUCTION (PATELLA TENDON GRAFT)* WITH AUTOLOGOUS CHONDROCYTEIMPLANTATION (FEMORAL CONDYLE) REHABILITATION PROTOCOLWEIGHT BEARING PHASE I0 - 12 weeks0-2 weeks: nonweight bearing 2-4 weeks: partial weight bearing (30 - 40 lbs) withcrutches 4-6 weeks: progress to one crutch 6-12 weeks: progress to full weightbearing without crutches

BRACE

ROM

THERAPEUTIC EXERCISES1-2 weeks: active/passive ROM, active knee extension 90-60 , quad/hamstring sets,SLR, begin active hamstring strengthening 2-6 weeks: progress exercises in phaseI, add resistance above the knee, begin closed chain exercises keeping weightbearing restrictions in mind 6-10 weeks: weight shifting activities, progressclosed chain and hamstring strengthening, forward/backward treadmill walking,begin Stairmaster 10-12 weeks: progress closed chain activities using resistanceless than patient's body weight, open chain knee extension 90-30 , continuehamstring strengthening, balance activities

0-2 weeks: locked in full extension (removed for CPM and exercise) 2-6 weeks:gradually open 20 at a time as patient gains quad control - discontinue use ofbrace when patient has good quad control, but no sooner than 6 weeks

0-4 weeks: CPM: use in 2 hour increments for 6 8 hours per day, begin at 0-30 , 1cycle/minute after week 3, increase flexion by 5-10 daily

PHASE II12 weeks 6 months

Full with a normalized gait pattern

None

Maintain full active/passive range

Advance closed chain exercises, begin full ROM active knee extension*, progresstreadmill - initiate light jog

PHASE III6 - 12 months


None

Full and pain-free

Initiate slight incline with treadmill jog, emphasize single leg loading, beginprogressive running and agility programincluding sport-specific activities

*Monitor for signs of patella femoral irritation



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ACL SEMITENDINOSUS AUTOGRAFT RECONSTRUCTION REHABILITATION PROTOCOLWEIGHT BEARING PHASE I0 - 4 weeksAs tolerated with crutches*

BRACE

ROM

THERAPEUTIC EXERCISEHeel slides, quad sets, patellar mobs gastroc/soleus stretch***, SLR with brace infull extension until quad strength prevents extension lag****


As tolerated

PHASE II4 - 6 weeks




Progress to weight bearing gastroc/soleus stretch and closed chain activities,begin hamstring stretching



None


Begin hamstring strengthening, advance closed chain strengthening, progressproprioception activities, begin Stairmaster/Nordic Trac, begin running straightahead at 12 weeks


Full

None

Full and pain-free




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Full

None

Full and pain-free

Gradual return to sports participation, maintenance program for strength and

endurance

*Modified with concomitantly performed meniscus repair/transplantation orarticular cartilage procedure **Brace may be removed for sleeping after firstpost-operative visit (day 7-10) ***This exercise is to be completed in a non-weight bearing position ****NO hamstring stretching until 4 weeks post-operative



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AUTOLOGOUS CHONDROCYTE IMPLANTATION (FEMORAL CONDYLE ONLY) REHABILITATION PROTOCOLWEIGHT BEARING PHASE I0 - 12 weeks0-2 weeks: nonweight bearing 2-4 weeks: partial weight bearing (30 - 40 lbs) 4-6weeks: progress to use of one crutch 6-12 weeks: progress to full weight-bearing

BRACE

ROM

THERAPEUTIC EXERCISE0-2 weeks: Quad sets, SLR, hamstring isometrics - complete exercises in brace ifquad control is inadequate 2-6 weeks: Begin progressive closed chain exercises* 6-10 weeks: Progress bilateral closed chain strengthening, begin opened chain kneestrengthening 10-12 weeks: Progress closed chain exercises using resistance lessthan patient's body weight, progress to unilateral closed chain exercises, beginbalance activities

0-2 weeks: locked in full extension (removed for CPM and exercise) 2-4 weeks:Gradually open brace 20 at a time as quad control is gained - discontinue use ofbrace when quads can control SLR without an extension lag

0-4 weeks: CPM: use in 2 hour increments for 6 - 8 hours per day at 1 cycle/minutebegin at 0-30 increasing 5-10 daily per patient comfort patient should gain atleast 90 by week 4 and 120-130 week 6 by



None

Full active range of motion

Advance bilateral and unilateral closed chain exercises with emphasis onconcentric/eccentric control, continue with biking, stairmaster and treadmill,progress balance activities



None

Full and pain-free

Advance strength training, initiate light plyometrics and jogging - start with 2minute walk/2 minute jog, emphasize sport-specific training



None


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Full and pain-free

Continue strength training - emphasize single leg loading, begin a progressiverunning 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 - avoidloading 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


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AUTOLOGOUS CHONDROCYTE IMPLANTATION OF THE PATELLOFEMORAL JOINT WITH DISTALREALIGNMENT REHABILITATION PROTOCOL WEIGHT BEARING PHASE 1 0-12 weeks BRACE ROMTHERAPEUTIC EXERCISE

* 0-6 wks: heel touch weight bearing (20%)

0-2 wks: locked in full 0-6 wks: CPM for a extension (remove for total of 6-8hrs/day to CPM/exercise/hygiene) 40 to 60 as advised 2-6 wks: 0-40 or 60 as

advised ** May let knee hang to 90 up to 3x/day for a few minutes to preventstiffness 6+ wks: progress to full ROM; D/C CPM

1-6 wks: quad sets, co-contractions isometric abduction/adduction ankle strength/all ROM's 6-10 wks: SLR, partial wall sits, terminal knee ext w/ TB, no greaterthan 445 continue previous exercises 10-12 wks: hamstring strength, TB resistenceat 0-45 light open chain ex.-all ROMs at knee and hip

6-8 wks: transition 6-8 wks: wean from to full weight brace bearing

PHASE 2 12 weeks6 months


None

Full

Begin treadmill walking at slow pace, progress to balance/proprioception ex.initiate sports-specific drills

PHASE 3 6 months12 months

Full

None

Full

Advance close chain strength ex. focsus on single leg strength, progress towalking and bac plyometric movements TM, initiate light plymetric movements

PHASE 4 12 months18 months

Full

None

Full

Continue strength training, emphasize single leg loading, progressive running/agility program, high impact at 18 mo


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* WB is restricted for the first 4-6 weeks to protect the bony portion of theprocedure ** Post operative stiffness in flexion following trochlear/patellarimplantation is not uncommon and patients are encouraged to achieve 90 of flexionat least 3x/day out of the brace after their first post operative visit (7-10days) Note: If significant pain or swelling occurs with any activity, the protocolmust be modified to decrease symptoms as per physician recommendations



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AUTOLOGOUS CHONDROCYTE IMPLANTATION (TROCHLEA/PATELLA)* REHABILITATION PROTOCOLPHASE I0 - 12 weeks

WEIGHT BEARING0-2 weeks: nonweight bearing 2-4 weeks: partial weight bearing (30 - 40 lbs) 4-8weeks: continue with partial weight bear status - progress to use of one crutch 8-12 weeks: progress to full weight bearing and discard crutches

BRACE0-2 weeks: locked in full extension (removed for CPM and exercise) 2-4 weeks:Locked at 0 with

ROM0-4 weeks: CPM: use in 2 hour increments for 6 - 8 hours per day - begin at 0-30 -1 cycle/minute after week 3, increase flexion by 5 10 daily 6-8 weeks: gain 0-90 8weeks: gain 0-120

THERAPEUTIC EXERCISE1-4 weeks: Quad sets, SLR, hamstring isometrics - complete exercises in brace ifquad control is inadequate 4-10 weeks: begin isometric closed chain exercises - at

6-10 weeks, may begin weight shifting activities with involved leg extended iffull weight bearing - at 8 weeks begin balance activities and stationary bike withlight resistance 10-12 weeks: hamstring strengthening, theraband 0-30 resistance,light open chain knee isometrics

weight bearing 4-6 weeks: Begin to open 20 to 30 with ambulation - discontinue useafter 6 weeks

PHASE II12 weeks 6 monthsFull with a normalized gait pattern None Full range of motion Begin treadmillwalking at a slow to moderate pace, progress balance/proprioceptive activities,initiate sport cord lateral drills

PHASE III6 - 9 monthsFull with a normalized gait pattern None Full and pain-free Advance closed chainstrengthening, initiate unilateral closed chain exercises, progress to fastwalking and backward walking on treadmill (initiate incline at 8-10 months),initiate light plyometric activity

PHASE IV9 - 18 monthsFull with a normalized gait pattern None Full and pain-free Continue strengthtraining - emphasize single leg loading, begin a progressive running and agilityprogram - high impact

activities may begin at 16 months *Most trochlear/patellar defect repairs areperformed in combination with a distal realignment if pain-free is restricted forthe first 4-6 weeks to protect the bony portion of the distal realignment duringhealing **May consider patellofemoral taping or stabilizing brace if improperpatella tracking stresses implantation ***If pain or swelling occurs with anyactivities, they must be modified to decrease symptoms NOTE: Post-operativestiffness in flexion following trochlear/patellar implantation is not uncommon andpatients are encouraged to achieve 90 of flexion at least 3x/day out of the braceafter their first post-op visit (day 7-10)


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DISTAL FEMORAL OSTEOTOMY REHABILITATION PROTOCOL

WEIGHT BEARING PHASE 1 0-6 Weeks

BRACE

THERAPEUTIC EXERCISE

0-2 wks: heel touch weight bearing (20%)

0-2 wks: locked in full extension for all activities including sleep (remove forexercise/hygiene) 2-4 wks: unlock brace

Heel Slides 0-90 quad sets, ankle pumps calf/ hamstring streching resistedplantar/ dorsiflexion

2-4 wks:WB stays at 20%

4-6 wks: As per MD 6 wks: wean from brace instructions advance WB 20% per week toFWB with brace unlocked

PHASE 2 6-8 weeks

As tolerated with Discontinue use per crutches-begin to MD instruction advance toa normal gait pattern without crutches

Progress exercises in phase 1, SLR without brace if able to maintain fullextension, initiate stationary bike with low resistence

PHASE 3 8 weeks3 months


None

Mini-squats 0-45 progressing to step-ups, leg press 0-60 closed chain terminalknee extensions, toe raises, balance exercises hamstring curls, increase bikeresistence Progress close chain activities, begin treadmill walking, swimming, andsports-specific activities

PHASE 4 3-9 months

Full

None

* No closed chain kinetic exercises until six weeks post op COPYRIGHT 2003 CRC

BRIAN J. COLE, MD, MBA


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DISTAL REALIGNMENT REHABILITATION PROTOCOL WEIGHT BEARING PHASE 1 0-12 weeks * 0-6wks: heel touch weight bearing (20%) 6-8 wks: transition to full weight bearingBRACE ROM THERAPEUTIC EXERCISE

0-2 wks: locked in full extension (remove for exercise/hygiene) 2-6 wks: unlocked

Immediate range of motion as tolerated

1-6 wks: quad sets, co-contractions isometric abduction/adduction ankle strength,all ROM's 6-10 wks: SLR, partial wall sits, terminal knee ext w/ TB, no greaterthan 45, continue previous exercises

6+ wks: full weight bearing

6-8 wks: wean from brace

6+ wks: progress to full ROM

10-12 wks: hamstring strength, TB resistance 0-45 light open chain ex. With allROMs at knee and hip, continue previous exercise Begin treadmill walking at slowpace, progress to balance/ proprioception ex. initiate sports specific drills

PHASE 2 12 wks16 wks


None

Full


Full

None

Full

Advance close chain strength ex. focus on single leg strength, progress to walkingand backward movement TM, initiate light plyometric movements Continue strengthtraining, emphasize single leg loading, progressive running/ agility program, highimpact activities at 16 months


Full

None

Full


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* WB is restricted for 4-6 weeks to protect the bony portion of the procedureNote: If significant pain or swelling occurs with any activity, the protocol mustbe modified to decrease symptoms as per physician recommendations COPYRIGHT 2003CRC BRIAN J. COLE, MD, MBA


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HIGH TIBIAL OSTEOTOMY REHABILITATION PROTOCOLWEIGHT BEARING PHASE I0 - 4 weeks0-2 weeks: PWB (25%) with crutches and brace locked in extension 2-4 weeks:advance to full weight bearing with crutches with brace locked in extension

BRACE

ROM

THERAPEUTIC EXERCISES**Heel slides 0 - 90 , quad sets, ankle pumps, calf/hamstring stretches***, SLR withbrace locked in full extension, resisted plantarflexion

Locked in full extension for all activities (including sleeping) - remove forexercise and CPM use (if applicable)

As tolerated CPM* for 2 hours, twice daily, from 0 - 90 of flexion out of brace

PHASE II4 - 6 weeks

As tolerated with crutches - begin to advance to a normalized gait pattern withoutcrutches

Unlocked for ambulation removed for sleeping

Discontinue CPM if knee flexion is at least 90

Progress exercises in phase I, SLR without brace if able to maintain fullextension, initiate stationary bike with low resistance



Discontinue use - per physician


Mini-squats 0-45 - progressing to step-ups, leg press 0-60 , closed chain terminalknee extensions, toe raises, balance activities, hamstring curls, increase tomoderate resistance on bike


Full

None

Full and pain-free

Progress closed chain activities, begin treadmill walking, swimming, and sport-specific activities

*CPM used if concomitant arthroscopy performed at the time of osteotomy **No


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closed chain exercises until 6 weeks post-op ***This exercise is to be completedin a non-weight bearing position



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MENISCAL ALLOGRAFT TRANSPLANTATION REHABILITATION PROTOCOL

WEIGHT BEARING PHASE I0 - 8 weeks0-2 weeks: partial weight bearing (up to 50%) 2-6 weeks: as tolerated withcrutches discontinue use of crutches at 4 weeks when gait normalizes

BRACE

ROM

THERAPEUTIC EXERCISE**0-2 weeks: Heel slides, quad sets, patellar mobs, SLR, SAQ 2-8 weeks: addition ofheel raises, total gym (closed chain), and terminal knee extensions activitieswith brace until 6 weeks, then without brace to tolerance NOTE: No weight bearingwith flexion >90 during phase I

0-1 week: locked in full extension for sleeping* 0-2 weeks: locked in extensionfor all weight bearing activities 2-6 weeks: Locked 0 - 90 - discontinue braceafter 6 weeks

0-2 weeks: non-weight bearing 0-90 2-8 weeks: as tolerated, non-weight bearing

PHASE II8 - 12 weeks

Full, without crutches

None


Progress closed chain activities, begin hamstring work, lunges 0-90 of flexion,proprioception exercises, leg press 0-90 - flexion only, begin stationary bike

PHASE III12 - 16 weeks


None

Full and pain-free

Progress phase II exercises and functional activities such as: 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



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MENISCAL ALLOGRAFT TRANSPLANTATION WITH AUTOLOGOUS CHONDROCYTE IMPLANTATIONREHABILITATION PROTOCOLWEIGHT BEARING PHASE I0 - 12 weeks0-2 weeks: nonweight bearing 2-4 weeks: partial weight bearing (30 - 40 lbs) 4-6weeks: progress to use of one crutch 6-12 weeks: progress to full weight bearing

BRACE

0-2 weeks: locked in full extension (removed for CPM and exercise) 2-4 weeks:Gradually open brace 20 at a time as quad control is gained - discontinue use ofbrace when quads can control SLR without extension lag.

ROM10 days - 4 weeks: CPM use in 2 hour increments for 6 - 8 hours per day- begin at0-40 and

THERAPEUTIC EXERCISE0-2 weeks: Quad sets, SLR, hamstring isometrics - complete exercises in brace ifquad control is inadequate 2-6 weeks: Begin progressive closed chain exercises* 6-10 weeks: Progress bilateral closed chain strengthening, begin opened chain kneestrengthening 10-12 weeks: Progress closed chain exercises using resistance less

than patient's body weight, progress to unilateral closed chain exercises, beginbalance activities

increase by 5-10 daily, as tolerated patient should gain full ROM by 12 weeks



None


Advance bilateral and unilateral closed chain exercises with emphasis onconcentric/eccentric control, continue with biking, Stairmaster, and treadmill,progress balance activities



None

Full and pain-free

Advance strength training, initiate light plyometrics and jogging - start with a 2minute walk/2 minute jog, emphasize sport-specific training



None


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Full and pain-free

Continue strength training - emphasize single leg loading, begin a progressiverunning 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 - avoidloading 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



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ARTHROSCOPIC MENISCUS REPAIR REHABILITATION PROTOCOL WEIGHT BEARING BRACE ROMTHERAPEUTIC EXERCISE

Phase 1 0-6 weeks 0-6 wks: weight 0-2 wks: locked in bearing as extension (removefor tolerated with hygiene/exercise) crutches unless otherwise directed 2-4 wks:unlocked (remove for exercise/ hygiene/sleep) 6-8 wks: wean from crutches Phase 28 weeks- FWB without 12 weeks crutches discontinue between 4-6 wks

0-4 wks: Full ROM w no weight bearing at flexion angles of 90 or more

0-4 wks: heel slides, quad sets SLR, SAQ, co-contractions isometric ab/adduction,patellar mobilization, ankle strength

4-8 wks: Full ROM w 4-8 wks: partial wall sits, no PROM as tolerated greater than90, TKE with flexion angles of 90 or more

None

Full active ROM

Progress closed-chain exercise begin hamstring work, lunges 0-90, proprioception

exercises, leg press 0-90, begin stationary bike Progress phase 2 exercises focuson single leg strength running, jogging, plyometrics, sport specific drills

Phase 3 12 weeks- Full with normal 16 weeks gait pattern

None

Full

NOTE: Patients should avoid tibial rotation for 4-6 weeks

COPYRIGHT 2003 BRIAN J. COLE, MD, MBA


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ARTHROSCOPIC MENISECTOMY/ CHONDRAL DEBRIDEMENT REHABILITATION PROTOCOL

WEIGHT BEARING Phase 1 0-2 weeks 0-2 wks: crutches used for 24-48 hours, advanceto full weight bearing as tolerated

ROM


0-2 wks: Immediate full ROM should be attained

0-2 wks: heel slides, quad sets SLR, co-contractions isometric ad/abduction ex.,patellar mobilization, ankle strength

Phase 2 2-4 weeks

2-4 wks: full weight bearing

2-4 wks: progress to full ROM

2-4 wks: wall sits, lunges, balance exercises

Phase 3 4-6 weeks

4-6 wks: FWB

4-6 wks: Full ROM

4-6 wks: leg press, leg curls, squats, plyometric exercises



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MICROFRACTURE - FEMORAL CONDYLE REHABILITATION PROTOCOL

WEIGHT BEARING PHASE I0 - 8 weeksTouchdown weight bearing (20-30%) for the first 6-8 weeks.

BRACE

ROM

THERAPEUTIC EXERCISEPassive stretching/exercise for the first 6 - 8 weeks, quad/hamstring isometrics

None

Use of a CPM for 6-8 hours/day - set at a rate of 1 cycle/ minute, advancing 10daily - begin at a level of flexion that is comfortable for the patient - advanceto full flexion as tolerated


Gradual return to full weight bearing

None


Progressive active strengthening

PHASE III12 weeks and beyond

Full

None

Full and pain-free

Return to full activities, including cutting, turning, and jumping



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MICROFRACTURE - TROCHLEAR/PATELLAR DEFECT REHABILITATION PROTOCOL

WEIGHT BEARING

BRACE

ROM


PHASE I0 - 8 weeks

Weight bearing as tolerated

Locked 0 - 40 of flexion for weight bearing

Use of a CPM for 6-8 hours/day - begin at a rate of 1 cycle/ minute, ranging from0 - 40

Passive stretching/exercise for the first 6 - 8 weeks, quad/hamstring isometrics


Full

None


Begin closed chain activities, emphasizing a patellofemoral program

PHASE III

12 weeks and beyond

Full

None

Full and pain-free

Return to full activities, including cutting, turning, and jumping



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OSTEOCHONDRAL ALLOGRAFT TRANSPLANT REHABILITATION PROTOCOL

WEIGHT BEARING PHASE I0 - 6 weeksNon-weight bearing

BRACE

ROM

THERAPEUTIC EXERCISEPROM/AAROM to tolerance, patella and tibiofibular joint mobs (grades I & II),quad, hamstring, and gluteal sets, hamstring stretches, hip strengthening, SLR

0-1 week: locked in full extension (removed for CPM and exercises) 2-4 weeks:Gradually open brace in 20 increments as quad control is gained - discontinue useof brace when quads can control SLR without an extension lag

0-6 weeks: CPM: use for 6-8 hours per day - begin at at 0-40 increasing 5-10 dailyper patient comfort patient should gain 100 by week 6

PHASE II6 - 8 weeks

Partial weight bearing (25%)

None

Gradually patient should have 130 flexion of

Scar and patellar mobs, quad/hamstring continue to advance lower extremitystrengthening activities

increase flexion- strengthening, stationary bike for ROM,


Gradually return to full weight bearing

None

Progress to full and pain-free

Gait training, begin closed chain activities (wall sits, shuttle, mini-squats, toeraises), begin unilateral stance activities

PHASE IV12 weeks 6 months


None

Full and pain-free

Advance phase III activities


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OSTEOCHONDRAL AUTOGRAFT TRANSPLANT REHABILITATION PROTOCOL

WEIGHT BEARING PHASE I0 - 6 weeksNon-weight bearing

BRACE

ROM

THERAPEUTIC EXERCISEPROM/AAROM to tolerance, patella and tibiofibular joint mobs (grades I & ll),stationary bike for ROM, quad, hamstring, adduction, and gluteal sets, hamstringstretches, hip strengthening, SLR, ankle pumps

0-1 week: locked in full extension (remove for CPM and exercise) 2-4 weeks:gradually open brace in 20 increments as quad control is gained - discontinue useof brace when quads can control SLR without an extension lag

0-6 weeks: CPM: use for 6-8 hours per day - begin at 0-40 , 1 cycle/minuteincreasing 5-10 daily per patient comfort patient should gain 100 week 6 by

PHASE II6 - 8 weeks

Progress to full weight bearing

None

Gradually patient should obtain 130 of flexion

Gait training, scar and patellar mobs, closed chain activities (wall sits,shuttle, mini-squats, toe raises), begin unilateral stance activities

increase flexion- quad/hamstring strengthening, begin



None

Full and pain-free

Advance activities in phase II



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PCL and PCL/ACL RECONSTRUCTION REHABILITATION PROTOCOL

WEIGHT BEARING PHASE I0 - 4 weeksAs tolerated with crutches*

BRACE

ROM

THERAPEUTIC EXERCISESQuad sets, ankle pumps, SLR, hip ab/ adduction, hamstring/calf stretch, calf presswith theraband progressing to standing toe raises with full knee extension,standing hip extension

0-1 week: locked in full extension at all times 1-4 weeks: locked in fullextension for ambulation removed for exercise

0-1 week: None

1-4 weeks: passive only** to tolerance


As tolerated with crutches - gradually discontinue after 6-8 weeks

4-6 weeks: unlocked for gait training/exercise only 6-8 weeks: unlocked for allactivities 8 weeks: discontinue use


4-8 weeks: gait training, wall slides, mini-squats, resisted hip exercises instanding*** 8-12 weeks: stationary bike with light resistance (to begin) and seat

higher than normal, closed chain terminal knee extensions, Stairmaster, balanceand propriception activities, leg press (limiting knee flexion to 90 )



None


Advance closed chain strengthening, progress proprioception and balance

activities, maintain flexibility, begin treadmill walking to jog progression

PHASE IV9 monthsand beyond

Full

None

Full and pain-free


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Maintain strength, endurance, and function, begin sport-specific functionalprogression (backward running, cutting, grapevine, etc.), progress to running,initiate a plyometric program

*Modified with concomitantly performed meniscus repair/transplantation, articularcartilage procedure, or posterolateral corner reconstruction **Maintain anteriorpressure on proximal tibia as knee is flexed - prevent posterior sagging at all

times ***Resistance must be proximal to knee with hip ab/adduction exercises



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14434124 cartilage doc knee rehabilitation protocols

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