Phase I (Weeks 0-8)

1. Weightbearing: Weightbearing as tolerated in hinged knee brace locked in extension
2. Hinged Knee Brace: Locked in extension for ambulation – opened up 0–40° for ROM exercises
3. Range of Motion
   • Continuous Passive Motion (CPM) machine for 6–8 hours per day for 6–8 weeks
   • Set CPM to 1 cycle per minute – range from 0–40°
   • Passive range of motion and stretching under guidance of PT
4. Therapeutic Exercises
   • Quadriceps / Hamstring isometrics

Phase II (Weeks 8-12)

1. Weightbearing: Advance to full weightbearing as tolerated — discontinue crutch use
2. Discontinue use of hinged knee brace
3. Range of Motion – Advance to full / painless ROM (PROM / AAROM / AROM)
4. Therapeutic Exercises
   • Emphasize patellofemoral program
   • Closed-chain extension exercises
   • Hamstring curls
   • Toe raises
   • Balance exercises
   • Begin use of the stationary bicycle / elliptical

Phase III (Months 3-6)

1. Weightbearing: Full weightbearing
2. Range of Motion – Full / painless ROM
3. Therapeutic Exercises
   • Advance closed-chain strengthening exercises and proprioception activities
   • Sport-specific rehabilitation
   • Gradual return to athletic activity as tolerated – including jumping, cutting and pivoting sports
   • Maintenance program for strength and endurance

Phase I (Weeks 0-4)

1. Weightbearing: Touch-down weightbearing
2. Hinged Knee Brace: Locked in full extension for ambulation and sleeping
3. Range of Motion – PROM 0–30°
4. Therapeutic Exercises
   • Quadriceps strengthening / straight-leg raise with brace in full extension until quad strength prevents extension lag
   • Patellar mobilization
   • Non-weightbearing stretch of the Gastroc / Soleus

Phase II (Weeks 4-6)

1. Weightbearing: Advance to WBAT using crutches for balance
2. Hinged Knee Brace: Open between 0 and 30°
3. Range of Motion – Maintain full knee extension; work on progressive knee flexion (goal: 0–60° by week 6)
4. Therapeutic Exercises
   • Continue with Phase I exercises

Phase III (Weeks 6-8)

1. Weightbearing: Full weightbearing
2. Hinged Knee Brace: Open between 0 and 60°
3. Range of Motion – PROM / AAROM / AROM – progress to full ROM
4. Therapeutic Exercises
   • Continue with quadriceps strengthening
   • Start open-chain calf strengthening with theraband

Phase IV (Weeks 8-12)

1. Weightbearing: Full weightbearing
2. Hinged Knee Brace: Unlocked
3. Range of Motion – Full ROM
4. Therapeutic Exercises
   • Half squats / step downs
   • Proprioception activities
   • Closed-chain strengthening
   • Start stationary bike

Phase V (Months 3-9)

1. Therapeutic Focus
   • Advance closed-chain strengthening and proprioception activities
   • Start elliptical / jogging at 6 months
   • Return to athletic activity as tolerated at 9 months post-op

Phase I (Weeks 0-4)

1. Weightbearing: As tolerated with crutches (may be modified if concomitant posterolateral corner reconstruction, meniscal repair / meniscal transplant or articular cartilage procedure is performed)
2. Hinged Knee Brace
   • Locked in full extension for ambulation and sleeping (Weeks 0–1)
   • Locked in full extension for ambulation – removed for therapy sessions (Weeks 1–4)
3. Range of Motion
   • Weeks 0–1: None
   • Weeks 1–2: PROM 0–30°
   • Weeks 2–4: PROM 0–90°
   • MAINTAIN ANTERIOR PRESSURE ON PROXIMAL TIBIA AS KNEE IS FLEXED FROM WEEK 1–4 — PREVENT POSTERIOR SAGGING AT ALL TIMES
4. Therapeutic Exercises
   • Quad / Hamstring sets and ankle pumps
   • Straight-leg raise with brace in full extension until quad strength prevents extension lag
   • Hip abduction / adduction – for hip pain
   • Hamstring / Calf stretch – calf press with theraband progressing to standing toe raises with knee in full extension

Phase II (Weeks 4-12)

1. Weightbearing: As tolerated with crutches – discontinue crutch use at 6–8 weeks post-op
2. Hinged Knee Brace
   • Weeks 4–6: Unlocked for gait training / exercise only
   • Weeks 6–8: Unlocked for all activities
   • Discontinue brace at 8 weeks post-op
3. Range of Motion – Maintain full knee extension; work on progressive knee flexion (goal of 110° by week 6)
4. Therapeutic Exercises
   • Weeks 4–8: Gait training, wall slides (0–30°), mini-squats (0–30°), leg press (0–60°)
   • Weeks 8–12: Stationary bicycle (seat higher than normal), Stairmaster, closed-chain terminal knee extension, leg press (0–90°), balance and proprioception activities

Phase III (Weeks 12–9 Months)

1. Weightbearing: Full weightbearing with normalized gait pattern
2. Range of Motion – Full / painless ROM
3. Therapeutic Exercises
   • Advance closed chain strengthening exercises
   • Progress with proprioception / balance activities
   • Maintain flexibility
   • Begin treadmill walking – progress to jogging

Phase IV (9 Months and Beyond)

1. Therapeutic Focus
   • Maintain strength, endurance and function – initiate plyometric program
   • Begin cutting exercises and sport-specific drills
   • Return to sports as tolerated

Comments

• AVOID ACTIVE HAMSTRING ACTIVITY AND ACTIVE KNEE EXTENSION FROM 90–70° UNTIL POST-OP WEEK 4

Phase I (Weeks 0-8)

1. Weightbearing
   • Weeks 0–2: Partial weightbearing (up to 50%)
   • Weeks 2–6: Advance to WBAT with crutches (discontinue crutches at 4 weeks post-op if gait normalized)
2. Hinged Knee Brace
   • Worn for 6 weeks post-op
   • Locked in full extension for ambulation and sleeping – remove for hygiene (Week 1)
   • Locked in full extension for ambulation – remove for hygiene and sleeping (Week 2)
   • Set to range from 0–90° for ambulation – remove for hygiene and sleeping (Weeks 3–6)
   • Discontinue brace at 6 weeks post-op
3. Range of Motion – PROM → AAROM → AROM as tolerated
   • Weeks 0–2: Non-weightbearing 0–90°
   • Weeks 2–8: Full non-weightbearing ROM as tolerated – progress to flexion angles greater than 90°
4. Therapeutic Exercises
   • Weeks 0–2: Quadriceps sets, heel slides, straight leg raises, patellar mobilizations, co-contractions
   • Weeks 2–8: Add heel raises and terminal knee extensions
   • Activities in brace for first 6 weeks – then without brace
   • No weightbearing with flexion > 90° during Phase I
   • Avoid tibial rotation for first 8 weeks to protect the meniscal allograft

Phase II (Weeks 8-12)

1. Weightbearing: As tolerated
2. Range of Motion – Full active ROM
3. Therapeutic Exercises
   • Progress to closed chain extension exercises; begin hamstring strengthening
   • Lunges – 0–90°, Leg press – 0–90° (flexion only)
   • Proprioception exercises
   • Begin use of the stationary bicycle

Phase III (Months 3-6)

1. Weightbearing: Full weightbearing with normal gait pattern
2. Range of Motion – Full / painless ROM
3. Therapeutic Exercises
   • Continue with quad and hamstring strengthening
   • Focus on single-leg strength
   • Begin jogging / running
   • Plyometrics and sport-specific drills
   • Gradual return to athletic activity as tolerated (6 months post-op)
   • Maintenance program for strength and endurance

Phase I (Weeks 0-6)

1. Weightbearing: Non-weightbearing
2. Bracing
   • Hinged knee brace locked in extension (week 1) – remove for CPM and rehab with PT
   • Weeks 2–6: Gradually open brace in 20° increments as quad control is obtained
   • D/C brace when patient can perform straight leg raise without an extension lag
3. Range of Motion
   • Continuous Passive Motion (CPM) machine for 6–8 hours per day for 6–8 weeks
   • Set CPM to 1 cycle per minute – starting at 40° of flexion
   • Advance 10° per day until full flexion is achieved (should be at 100° by week 6)
   • PROM / AAROM and stretching under guidance of PT
4. Therapeutic Exercises
   • Patellar mobilization
   • Quad / Hamstring / Adductor / Gluteal sets – Straight leg raises / Ankle pumps

Phase II (Weeks 6-8)

1. Weightbearing: Partial weightbearing (25% of body weight)
2. Range of Motion – Advance to full / painless ROM (patient should obtain 130° of flexion)
3. Therapeutic Exercises
   • Continue with Quad / Hamstring / Core strengthening
   • Begin stationary bike for ROM

Phase III (Weeks 8-12)

1. Weightbearing: Gradually return to full weightbearing
2. Range of Motion – Full / painless ROM
3. Therapeutic Exercises
   • Begin closed chain exercises – wall sits / shuttle / mini-squats / toe raises
   • Gait training
   • Continue with Quad / Hamstring / Core strengthening
   • Begin unilateral stance activities

Phase IV (Months 3-6)

1. Weightbearing: Full weightbearing with a normal gait pattern
2. Therapeutic Exercise
   • Advance closed chain strengthening exercises, proprioception activities
   • Sport-specific rehabilitation – jogging at 4–6 months
   • Return to athletic activity – 9–12 months post-op
   • Maintenance program for strength and endurance