POST-OP DAYS 1 – 14

• Dressing:
• POD 1:  Debulk dressing
• POD 2:  Change dressing, keep wound covered
• POD 7-10:  Sutures out, D/C TED hose when effusion resolved
• Brace x 8 weeks – Locked in extension for ambulation. 
• Crutches – Partial weight bearing (PWB)
• Patella mobilization
• Calf pumping
• AAROM 0-45 degrees (passive extension, active flexion, heel slides)
• Passive extension with heel on bolster or prone hangs
• Electrical stimulation – sub-maximal quad sets for muscle re-education
• Quad sets, Co-contractions quads / hamstrings
• Standing straight leg raise (SLR) x 4 (in brace)
• Gentle hamstring stretch
• Ice pack with knee in full extension after exercise

GOALS

• Full passive extension
• Good quad control
• Pain / effusion controlled

WEEKS 2 – 4

• Brace x8 weeks – Locked in extension for ambulation
• Crutches – Weight bearing as tolerated (WBAT), D/C when gait is normal
• Continue appropriate previous exercises
• AAROM 0-70 degrees (passive extension, active flexion)
• SLR x4 on mat (in brace)
• Hamstring curls 0-45 degrees on weight machine with light resistance
• Double leg heel raises
• Proprioceptive training (in brace)
• Single leg standing in parallel bars
• Double leg BAPS for weight shift
• Stretches – Hamstring , ITB

GOALS

• ROM 0 – 70 degrees
• No extensor lag

WEEKS 4 – 6

• Brace x 8 weeks – Locked at 0-30 degrees for ambulation
• Continue appropriate previous exercises
• AAROM 0-90 degrees (passive extension, active flexion)
• Standing SLR x 4 (in brace) with Theraband bilaterally
• Hamstring curls 0-90 degrees on weight machine with light resistance
• Forward, lateral, and retro step downs in parallel bars (in brace 0-45 degrees)
• No knee flexion past 45 degrees (small step)
• Single leg heel raises (in or out of brace)
• Elliptical trainer (in brace)

GOALS

• Normal gait
• ROM 0-90 degrees

WEEKS 6 – 8

• Brace x 8 weeks – Gradually open to available range
• Continue appropriate previous exercises
• AAROM, AROM through full range
• Active knee extension without weight (no brace)
• SLR x4 on mat with light weight below the knee (no brace)
• Leg press 0-60 degrees – Light resistance (no brace)
• Mini squats, wall squats 0-60 degrees (no brace)
• Proprioceptive training (in brace) – Single leg BAPS, ball toss and body blade
• Stationary bike (no brace) – Progressive resistance and time
• Treadmill – Forwards and backwards walking (in brace)
• Pool therapy (flutter kicks from hip with knee in extension

GOAL

• ROM 0-110 degrees

WEEKS 8 – 12

• D/C brace
• Continue appropriate previous exercises and following ex without brace
• PROM, AAROM, AROM to regain full motion
• Short arc quads
• Hamstring curls on machine through full range – Light to moderate resistance
• Leg Press 0-90 degrees – Light to moderate resistance
• Hip weight machine x4 bilaterally
• Fitter
• Slide Board
• Treadmill – Walking progression program

GOALS

• Full ROM
• Walk 2 miles at 15 min/mile pace

MONTHS 3 – 4

• Continue appropriate previous exercises
• Knee extension weight machine with light to moderate resistance
• Functional activities – Figure 8’s, gentle loops, large zigzags
• Treadmill – Walking progressive program

GOALS

• Equal thigh girth
• Equal quad flexibility in prone (heels to buttocks)
• Run 2 miles at easy pace

MONTHS 4 – 6

• Continue appropriate previous exercises
• Agility drills / Plyometrics
• Sit-up progression
• Stairmaster
• Running progression to track
• Transition to home / gym program

GOAL

• Return to all activities

*NO CONTACT SPORTS UNTIL 6 MONTHS POST-OP*