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Preoperative
- Decrease swelling, Normalize gait, strength and ROM.
- Extension: prone hangs or heel props (7-10 min)
- Flexion: wall slides, heel slides, active assist flexion
- Weight bearing as tolerated
- Treadmill: forward/backward (5-10min)
- Closed chain: leg press, total gym (10-50 deg), toe raisesOpen chain:
- Quad machine (90-30 deg), hamstring machine
- 4-way SLR. All exercises 3-5 sets, 12-15 reps
- Electrical stimulation for VMO PRN
- Low-impact activities (bike, treadmill walking)
- Ice/elevation: 20 min on/60 min off
- Passive extension/flexion activities
- Lower extremity strengthening as indicated
- All activities 3-4 times/day or as indicated
Postoperative (Days 1-14)
- Control swelling, restore ROM, normalize gait and strength
- Ace wrap with elevation-ankle pumps (20 min)
- Extension: heel props (7-10 min), or prone hangs
- Flexion: heel slides (7-10 min), advancing to wall slides, active assist flexion
- *avoid lying with pillow under knee*
- Weight bearing as tolerated
- SLR, quad sets, glute sets, hamstring sets
- As above 4-5 times/day while at home
- Treadmill: forward/backward (5-10 min)
- Calf, hamstring, hip flexor stretching (3 times,
- 30 sec hold) *emphasize heel to toe gait*
- 4-way SLR, quad sets, multi-angle isometrics (0-45-90 deg)
- Electrical muscle stimulation PRN (15 min)
- Partial squat (10-40 deg), toe raises with assistance PRN
- All exercises 3-5 sets, 12-15 reps
- Total Gym Level 1-3
Postoperative (Weeks 2-5)
- Full passive knee extension and flexion
- Extension: prone hangs or heel props (0-125 by 4 wks)
- Flexion: wall slides, heel slides, active assist flexion, bike (7-10 min)
- Treadmill: forward/backward (5-10 min)
- Increase grade with treadmill as tolerated
- Calf, hamstring, hip flexor stretching (3 times 30 sec hold)
- Closed chain: leg press (10-50), Total gym level (4-5)
- Push FROM without pain hamstring stretch, 4-way SLR,
- Toe raises, step ups, mini squats
- All exercises 3-5 sets, 12-15 reps
- *Implement within painfree ROM once normal gait and effusion control are achieved
- HS curls start at – 2 weeks for bone–patella–bone grafts and 4 weeks for HS grafts.
- Initiate proprioception exercises (pain-free)
- BAPS (start with ball 1 sitting and progress to standing-4 min)
- Double leg stand with rebounder
- Single leg stance/grid exercises (lunges, reaches)
- Standing 4-way hip theratubing exercises
- Lateral treadmill walking both directions
- Implement once patient is able to ambulate normally without pain (3-5 min)
Postoperative (Week 6-12)
- Criteria for progression:No effusion, painless full ROM, minimal crepitus. Score greater than 80 on Lysholm with no locking or instability, painfree low impact activity (bike, treadmill, walking, stepper on own)
- 3-4 times per week, 20-30 minutes
- Trampoline hopping bilaterally progressing to jogging, then single leg hopping (10 min)
- Fitter with ski poles progressing to no ski poles (7-10 minutes) BAPS – single leg
- Body blade Proprioceptive Star Excercises
- Week 10 – Light double leg hopping
- (multi-directional), lateral shuffles
- Total gym level 8-10 without pain, leg press (10-50), toe raises, step ups
- Hamstring machine, 4-way SLR
- All exercises 3-5 sets, 12-15 reps Mini squats, Partial lunges, single-leg toe raise
Postoperative (Week 13-24)
- Criteria for progression: no effusion, painless full ROM, minimal crepitus. Score great than 90 on Lysholm with no locking or instability Ratio of 80% involved to uninvolved on isokinetic test at 6 months post-op . Ratio of 80% on one-legged jump. Pain free low impact activity (bike, treadmill, walking, stepper)
- 3-4 times per week, 20-30 minutes
- Closed chain: leg press (10-50 deg), Toe raises. Total gym level 8-10 without pain.
- Open chain: Quad machine (90-30 deg), Hamstring machine
- All exercise’s 3 sets 15-20 each
- Walk/jog cycles: 3-5 min warm-up (walk); 10-30 sec jog/60 sec walk for 10-20 min; 3-5 min cool-down (walk). Gradually increase jog time and decrease walk time based upon patient response.
- Progressive strength training and agility/speed drills
- Program should be based upon specific patient needs / sport.
- Return to sport UPMC guidelines.
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