General Considerations

• Weight-bearing status:
 – 0–2 weeks: Non-weight bearing (NWB)
 – 2+ weeks: Weight bearing as tolerated (WBAT); hinged knee brace locked in extension for 8 weeks

• Range of Motion (ROM) Limitations:
 – 0–2 weeks: Locked in full extension
 – 2–4 weeks: 0–30 degrees
 – 4–6 weeks: 0–60 degrees
 – 6–8 weeks: 0–90 degrees
 – 8+ weeks: Full range

• No open-chain leg extensions for 8 weeks

0–2 Weeks: Wound Rest

• Knee immobilizer at all times
• Ice and modalities to reduce pain and inflammation

2–4 Weeks: Protect Repair and Maintain ROM

• Begin formal physical therapy
 – Prone active flexion and passive extension, range limited to 30 degrees
 – Begin straight leg raises
• Submaximal quadriceps setting
• Weight bearing as tolerated once able to perform straight leg raises comfortably
• Continue inflammation control

4–6 Weeks: Regain ROM

• Prone active flexion and passive extension, range to 60 degrees

6–8 Weeks: Progressive ROM

• Prone active flexion and passive extension, range to 90 degrees
• Begin multi-plane straight leg raises and closed kinetic chain strengthening focusing on quality vastus medialis oblique (VMO) function
• Normalize gait pattern
• Begin stationary bike
• Initiate pool program

8–10 Weeks

• Wean out of brace
• Begin open kinetic chain exercises, progressing to closed kinetic chain multi-plane hip strengthening
• Normalize gait pattern
• Restore full ROM
• Progress open and closed chain exercises from bilateral to unilateral work
• Increase intensity on stationary bike
• Begin treadmill walking program (forward and backward)
• Begin elliptical training

10–12 Weeks

• Expect full ROM
• Perform terminal quadriceps stretching
• Advance unilateral open and closed kinetic chain strengthening

12+ Weeks

• Continue to advance open and closed kinetic chain strengthening
• Increase intensity on bike, treadmill, and elliptical
• Increase difficulty and intensity of proprioception drills
• Begin gym strengthening: leg press, hamstring curls, abduction, and adduction exercises
 – Avoid knee extensions until week 16