Phase I (Weeks 0-4)

1. Sling immobilization with supporting abduction pillow to be worn at all times except for showering and rehab under guidance of PT
2. Range of Motion – True Passive Range of Motion Only to Patient Tolerance
   • Goals: 140° Forward Flexion, 40° External Rotation with elbow at side, 60–80° Abduction without rotation, Limit Internal Rotation to 40° with the shoulder in the 60–80° abducted position
   • Maintain elbow at or anterior to mid-axillary line when patient is supine
3. Therapeutic Exercise
   • No canes or pulleys during this phase
   • Codman Exercises / Pendulums
   • Elbow/Wrist/Hand Range of Motion and Grip Strengthening
   • Isometric Scapular Stabilization
4. Heat/Ice before and after PT sessions

Phase II (Weeks 4-8)

1. Discontinue sling immobilization
2. Range of Motion
   • 4–6 weeks: Gentle passive stretch to reach ROM goals from Phase I
   • 6–8 weeks: Begin AAROM → AROM as tolerated
3. Therapeutic Exercise
   • 4–6 weeks: Begin gentle AAROM exercises (supine position), gentle joint mobilizations (grades I and II), continue with Phase I exercises
   • 6–8 weeks: Progress to active exercises with resistance, shoulder flexion with trunk flexed to 45° in upright position, begin deltoid and biceps strengthening**
4. Modalities per PT discretion

Phase III (Weeks 8-12)

1. Range of Motion – Progress to full AROM without discomfort
2. Therapeutic Exercise
   • Continue with scapular strengthening
   • Continue and progress with Phase II exercises
   • Begin Internal/External Rotation Isometrics
   • Stretch posterior capsule when arm is warmed-up
3. Modalities per PT discretion

Phase IV (Months 3-6)

1. Range of Motion – Full without discomfort
2. Therapeutic Exercise
   • Advance strengthening as tolerated: isometrics → therabands → light weights (1–5 lbs)
   • 8–12 repetitions / 2–3 sets for Rotator Cuff, Deltoid and Scapular Stabilizers
   • Return to sports at 6 months if approved
3. Modalities per PT discretion

Comments

• IF BICEPS TENODESIS WAS PERFORMED – NO BICEPS STRENGTHENING UNTIL 8 WEEKS POST-OP

Phase I (Weeks 0-4)

1. Weightbearing: As tolerated with crutches (may be modified if concomitant 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)
   • Unlocked for ambulation and removed while sleeping (Weeks 1–4)
3. Range of Motion – AAROM → AROM as tolerated
4. Therapeutic Exercises
   • Quad / Hamstring sets
   • Heel slides
   • Non-weightbearing stretch of the Gastroc / Soleus
   • Straight-leg raise with brace in full extension until quad strength prevents extension lag

Phase II (Weeks 4-6)

1. Weightbearing: As tolerated — discontinue crutch use
2. Hinged Knee Brace: Discontinue brace use when patient has achieved full extension with no evidence of extension lag
3. Range of Motion – Maintain full knee extension; work on progressive knee flexion
4. Therapeutic Exercises
   • Closed-chain extension exercises
   • Hamstring curls
   • Toe raises
   • Balance exercises
   • Progress to weightbearing stretch of the Gastroc / Soleus
   • Begin use of the stationary bicycle

Phase III (Weeks 6-16)

1. Weightbearing: Full weightbearing
2. Range of Motion – Full / painless ROM
3. Therapeutic Exercises
   • Advance closed-chain strengthening and proprioception activities
   • Begin use of the Stairmaster / Elliptical
   • Start straight-ahead running at 12 weeks

Phase IV (Months 4-6)

1. Gradual return to athletic activity as tolerated
2. Maintenance program for strength and endurance

Phase I (Weeks 0-4)

1. Weightbearing: As tolerated with crutches (may be modified if concomitant 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)
   • Unlocked for ambulation and removed while sleeping (Weeks 1–4)
3. Range of Motion – AAROM → AROM as tolerated
4. Therapeutic Exercises
   • Quad / Hamstring sets and heel slides
   • Non-weightbearing stretch of the Gastroc / Soleus
   • Straight-leg raise with brace in full extension until quad strength prevents extension lag

Phase II (Weeks 4-6)

1. Weightbearing: As tolerated — discontinue crutch use
2. Hinged Knee Brace: Discontinue brace use when patient has achieved full extension with no evidence of extension lag
3. Range of Motion – Maintain full knee extension; work on progressive knee flexion
4. Therapeutic Exercises
   • Closed-chain extension exercises
   • Hamstring curls
   • Toe raises
   • Balance exercises
   • Progress to weightbearing stretch of the Gastroc / Soleus
   • Begin use of the stationary bicycle

Phase III (Weeks 6-16)

1. Weightbearing: Full weightbearing
2. Range of Motion – Full / painless ROM
3. Therapeutic Exercises
   • Advance closed-chain strengthening and proprioception activities
   • Begin use of the Stairmaster / Elliptical
   • Start straight-ahead running at 12 weeks

Phase IV (Months 4-6)

1. Continue strengthening (quad / hamstring) and flexibility
2. Begin cutting exercises and sport-specific drills
3. Maintenance program for strength and endurance
4. Return to sports at 6 months

Phase I (Weeks 0-12)

1. Weightbearing
   • Weeks 0–2: Non-weightbearing
   • Weeks 2–4: Partial weightbearing (30–40 lbs)
   • Weeks 4–8: Continue partial weightbearing; progress to one crutch at weeks 6–8
   • Weeks 8–12: Progress to full weightbearing and discontinue crutch use
2. Bracing
   • Weeks 0–2: Hinged knee brace locked in extension – remove for CPM and rehab with PT
   • Weeks 2–4: Locked in extension for weightbearing; open brace for NWB ROM 0–30°
   • Weeks 4–6: Open brace to 30° for ambulation
   • Discontinue brace at 6 weeks post-op
3. Range of Motion
   • Continuous Passive Motion (CPM) machine for 6–8 hours per day for 8 weeks
   • Set CPM to 1 cycle per minute – 0–30° for first 3 weeks
   • Starting week 3, increase flexion 5–10° per day until full flexion is achieved
   • Target: 90° by week 6 and 120° by week 8
   • PROM / AAROM and stretching under guidance of PT
4. Therapeutic Exercises
   • Weeks 0–4: Straight leg raises, quad sets, hamstring isometrics
   • Perform exercises in brace if quad control is inadequate
   • Weeks 4–10: Begin isometric closed-chain exercises
   • Week 6: Begin weight-shifting activities with operative leg in extension
   • Week 8: Begin balance exercises and stationary bike with light resistance
   • Weeks 10–12: Hamstring strengthening, theraband resistance exercises (0–30°), light open-chain knee isometrics

Phase II (Weeks 12-24)

1. Weightbearing: Full weightbearing with normal gait pattern
2. Range of Motion – Advance to full / painless ROM
3. Therapeutic Exercises
   • Gait training and treadmill use at slow–moderate pace
   • Progress balance and proprioception exercises
   • Start sport cord lateral drills

Phase III (Months 6-9)

1. Weightbearing: Full weightbearing with normal gait pattern
2. Range of Motion – Advance to full / painless ROM
3. Therapeutic Exercises
   • Advance closed-chain strengthening; begin unilateral closed-chain exercises
   • Progress to fast walking and backward walking on treadmill (add incline at 8 months)
   • Start light plyometric training

Phase IV (Months 9-18)

1. Weightbearing: Full weightbearing with normal gait pattern
2. Range of Motion – Full / painless ROM
3. Therapeutic Exercises
   • Continue closed-chain strengthening and proprioception activities
   • Emphasize single-leg loading
   • Sport-specific rehabilitation – jogging and agility training at 9 months
4. Return to impact athletics at 16 months if pain free
5. Maintenance program for strength and endurance

Phase I (Weeks 0-12)

1. Weightbearing
   • Weeks 0–2: Non-weightbearing
   • Weeks 2–4: Partial weightbearing (30–40 lbs)
   • Weeks 4–6: Continue partial weightbearing; progress to one crutch at weeks 6–8
   • Weeks 6–12: Progress to full weightbearing with discontinuation of crutch use
2. Bracing
   • Weeks 0–2: Hinged knee brace locked in extension – remove for CPM and rehab with PT
   • Weeks 2–4: Gradually open brace at 20° intervals as quad control is obtained
   • Discontinue 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 weeks
   • Set CPM to 1 cycle per minute – initially 0–30°
   • Increase flexion 5–10° per day until full flexion is achieved
   • Target: 90° by week 4 and 120° by week 6
   • PROM / AAROM and stretching under guidance of PT
4. Therapeutic Exercises
   • Weeks 0–2: Straight leg raises, quad sets, hamstring isometrics
   • Perform exercises in brace if quad control is inadequate
   • Weeks 2–6: Begin progressive isometric closed-chain exercises**
   • Week 6: Begin weight-shifting activities with operative leg in extension
   • Weeks 6–10: Progress bilateral closed-chain strengthening; begin open-chain knee strengthening
   • Weeks 10–12: Begin resisted closed-chain exercises (< body weight); progress to unilateral closed-chain exercises
   • Week 10: Begin balance exercises and stationary bike with light resistance

Phase II (Weeks 12-24)

1. Weightbearing: Full weightbearing with normal gait pattern
2. Range of Motion – Advance to full / painless ROM
3. Therapeutic Exercises
   • Advance bilateral and unilateral closed-chain exercises
   • Emphasis on concentric and eccentric control
   • Stationary bike, treadmill, Stairmaster, elliptical
   • Progress balance and proprioception exercises
   • Start sport-cord lateral drills

Phase III (Months 6-9)

1. Weightbearing: Full weightbearing with normal gait pattern
2. Range of Motion – Advance to full / painless ROM
3. Therapeutic Exercises
   • Advance strength training
   • Start light plyometric exercises
   • Start jogging and sport-specific training at 6 months

Phase IV (Months 9-18)

1. Weightbearing: Full weightbearing with normal gait pattern
2. Range of Motion – Full / painless ROM
3. Return to impact athletics at 16 months if pain free
4. Maintenance program for strength and endurance
5. Therapeutic Exercises
   • Continue closed-chain strengthening and proprioception activities
   • Emphasize single-leg loading
   • Sport-specific rehabilitation – running and agility training at 9 months

Comments

• Weeks 2–6 – Respect the repair site: if anterior lesion, avoid loading in full extension; if posterior lesion, avoid loading in flexion >45°