I.First postop week, begin POD #1

a. Rest, ice, compression wrap, elevation
i. Dressing change ok after POD #2
ii. Elevation with knee in maximal extension optimal as much as tolerated (i.e. pillows under calf or heel, not knee crease)
b. Ankle AROM as much as possible
c. Quad isometrics with knee in full passive extension
d. Straight leg raise ok in brace only
e. Gastroc isometrics
f. Patellar mobilization as soon as pain permits
g. Supine heel slides with terminal stretch to increase flexion as rapidly as possible
h. Sit and allow knee flexion over edge of table to speed flexion to 90
i. Supine knee passive extension with wedge under heel to promote full hyperextension
j. Prone heel hangs without weight, knee just beyond edge of treatment table to promote full hyperextension
k. Gait training WBAT with brace locked in full extension
l. Must sleep in brace

II. Second postop week

a. Same as first week, primary emphasis on increasing ROM to full
b. May wean off crutches as tolerated with brace locked at 0
c. Add supine straight leg raise out of brace when able to do so with no extensor lag
d. Side lying SLR begins
e. May begin stationary cycle without resistance
f. Must sleep in brace

III. Weeks three through six

a. Continue as above, full hyperextension and flexion primary goals
b. Rehab brace open 0 to 90, may be out of brace when at home, may wean from nighttime brace use as tolerated
c. More aggressive patellar mobilization
d. May gradually increase resistance on stationary cycle
e. Treadmill walking ok
f. Light sports cord or theraband resisted closed kinetic chain resistance training
g. Transition to functional knee brace at 4 to 6 weeks postop when swelling permits

IV. Weeks seven through twelve

a. Continue aggressive terminal stretching, should be full AROM early in this time frame
b. Continue treadmill, add incline progressively up to 7 to 10 degrees, backwards treadmill ok
c. Continue to increase resistance and endurance on stationary cycle
d. Begin light stair stepper, elliptical trainer, or precor if desired
e. Continue cord resisted strength, may transition to high rep low resistance weight training if motion full, not open chain knee extension
f. Quarter squats ok, no knee flexion angle greater than 90 for strength exercises
g. Continue brace when walking or active
h. Begin stork stands for proprioception

V. Weeks twelve through sixteen

a. As above for stretching
b. Increased resistance training, closed-chain, lunges, leg press, calf press minisquats, HS curls
c. Sportcord resisted forward, backward and lateral movement
d. May cycle outside in brace (road only, must remain seated in saddle)
e. Light jogging in brace
f. Add slide board and advanced proprioceptive training
g. No brace needed except for workouts
h. May begin golfing in brace
i. Increase intensity and duration of cardio training

VI. Weeks seventeen through twenty-four

a. Add plyometrics
b. Hill training with jogging and bicycle
c. Figure 8 runs, controlled intro to cutting maneuvers and sport specific activities in noncontact, noncompetitive environment
d. Advanced strength, proprio, and cardiovascular conditioning

VII. Return to sport criteria

a. MD clearance
b. Sports test 20/21 or better
c. Single-leg hop equal to contralateral
d. Adequate stability on ligament testing
e. Completed sport-specific functional progression
f. Functional knee brace for contact sports, jumping and landing or cutting and twisting until 1 year postop, then d/c