Revised 6/20/1999
Jim Davidson, M.D. Ohio Orthopaedics & Sports Medicine, Inc. (419)
424-0131
(Reproduced with permission of Duke University Medical Center, Division of Orthopaedic Surgery)
Phase I - Maximum Protection
Time: 0-3 weeks
Gait: Weight bearing as tolerated with crutches. Knee brace only as needed for comfort.
Wean
off of crutches by 2-3 weeks postop or when gait normalized.
Range of Motion:
Extension
- Work towards 0o of extension or
hyperextension equal to the opposite
side. It is ideal to obtain this by
2-3 weeks postop.
Flexion -
Work to patient’s tolerance. Should
obtain 90o 3 weeks postop.
Patella
Mobility - Therapist and patient mobilize
patella in superior/inferior and
medial/lateral directions.
Exercises:
No
resistance for the following exercises (gravity only):
* quad sets
* straight leg
raises
* hip abduction
* hip adduction
* hip extension
* hip extension
with flexed knee
* knee flexion
(standing and prone)
* leg extension
* short arc
quads
* toe raises
* semi-squats
Functional
Training:
Stationary Bike- Begin at
approximately 2 weeks postop for increasing range of
motion. Gradually progress time and tension. Try to use a bike
with toe clips and
emphasize “pull-up”.
Therapeutic Pool- Walking - forward
and backward
Hip flexion/extension
Hip
abduction/adduction
Knee flexion
Toe raises
Semi-squats
General Conditioning- Encourage
exercise of upper extremities on Nautilus,
Universal, Airdyne, or Upper Body
Ergometer.
Modalities:
Ice for 10-15 minutes after exercise and periodically trhoughout the day as
needed for control of pain and effusion. (cryocuff
often utilized)
Ace wrap of knee sleeve may also be used as needed for control of effusion.
Compression stocking as needed for lower extremity edema.
Phase II - Moderate Protection
Time: 3-8 weeks
Gait: Gait should be
normalized (equal stance time, full extension at heel strike and
normal flexion during swing phase).
Range of
Motion:
Extension - Full motion should have been obtained in phase I. If not, continue
stretching
aggressively.
Flexion - Continue
stretching until full motion (equal to opposite side) is
achieved. This should be done by 12-16
weeks postop.
Patella Mobility- Continue
patella mobilization until patella glides freely in all
directions.
Exercises:
Progressive resistance on the following exercises:
* hip abduction
* hip adduction
* hip extension
* hip extension
with flexed knee
* knee flexion
* toe raises
No resistance on open chain quadriceps work: (eliminate quadriceps lag)
* straight leg
raises
* leg extension
* short arc
quads
Progressive resistance on closed chain quadriceps work:
* wall sits
* step ups
* leg press
* knee extension
with Theraband resistance
* semi-squats
Isokinetic exercise:
* isokinetic
strengthening for hamstrings only.
Functional
Training:
Stationary Bike
- Continue with progression of time and tension. If
bike
has toe clips, patient may
perform one legged biking.
Patient may also ride
regular bikes at this time avoiding
uneven terrain.
Therapeutic
Pool:
Advanced pool activities:
* running - forward/backward
* lunges
* side-steps
* cariocas
* jumping jacks
* semi-squats (one leg)
* hopping
* swimming - patient may begin swimming but
should avoid
extensor thrust/hyperextension
and “frog kick” as with
breast stroke.
Stairclimber -
Proprioceptive
Training -
* BAPS board or KAT
* Balance activities
* Drills on mini-trampoline
Modalities:
Continue to use ice as needed following exercise for control of effusion.
Phase III - Functional Training
Time: 8-16 weeks (sometimes varies
according to type of graft and individual patient)
Criteria: Patients should demonstrate normal gait pattern,
good quadriceps control and
ability to lift at least 10 pounds with hamstrings.
Range of
Motion:
Extension - RED FLAG if not obtained
prior to this time.
Flexion - Continue stretching for full motion
which should be achieved in
phase II or III.
Patella Mobility - RED FLAG
if patella mobility not normalized during this
phase.
Exercises:
Progressive resistive exercises as listed in phase II with the addition of the
following
open chain quadriceps exercises:
Leg extension*
Short arc quads*
* avoid end range extension with large loads
Isokinetic exercise:
Isokinetic quadriceps and hamstring strengthening with anti-shear
device. Begin with high velocities
(120 /sec.). Extension effort
initially should be sub-maximal.
Functional
Training:
Running - Begin
running in pool or on mini-trampoline. Then
progress to
short distance (1/4 mile) on the track on the balls of feet. Add
approximately 1/4 - 1/2 mile per week. Add
retro-backward
running approximately 100 yards for every 1/4 mile forward
running.
Sprint work - sprint 50 yd distance with gradual warm up and
cool down. Gradually build up speed
avoiding sudden starts and
stops.
Jump rope - Start with 3-5
minutes and progress to 10-15 minutes with varying
footwork.
Shuttle 2000 - Bilateral jumps, jump off of both and land on involved leg, and
unilateral jumps.
Skill and agility drills:
* side-steps
* cariocas/crossover runs
* figure 8’s - large (20 yds) and small (10 yds)
* towel jumps - lateral and crossover
* shuttle runs/suicides - alternate forward leg on touch down
* one leg hops
* burst start and stop sprints
* cutting
* jumping off of trampoline or step on operated leg (lateral,
forward, backward)
Modalities:
Continue to use ice as long as effusion persists.
Phase IV -
Return to Activity
Time: 5-6 months
Functional
Training:
Sport specific skill and agility drills
Return to sports - Patients should initially return to sports in non-competitive
situations and should
caution against playing fatigued. Gradual
return to competitive
sports is indicated at 9-12 months postop
with the use of a
functional brace if desired by patient and
physician.
*** Protocol altered to fit the needs
of individuals as appropriate.