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
   • 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 6–8 weeks
   • Set CPM to 1 cycle per minute – starting at 40° of flexion
   • Advance 10° per day until full flexion is achieved (target 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
   • Stationary bike for ROM

Phase II (Weeks 6-8)

1. Weightbearing: Advance to full weightbearing as tolerated — discontinue crutch use
2. Range of Motion – Advance to full / painless ROM (goal: 130° of flexion)
3. Therapeutic Exercises
   • Closed-chain exercises – wall sits, shuttle, mini-squats, toe raises
   • Gait training
   • Patellar mobilization
   • Begin unilateral stance activities

Phase III (Weeks 8-12)

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
   • Jogging at 3 months
   • Higher-impact activities at 4–6 months
4. Maintenance program for strength and endurance

Phase I (Weeks 0-2)

1. Weightbearing: As tolerated with crutches (for balance) × 24–48 hours – progress to WBAT
2. Range of Motion – AAROM → AROM as tolerated
   • Goal: Immediate full range of motion
3. Therapeutic Exercises
   • Quad and hamstring sets
   • Heel slides
   • Co-contractions
   • Isometric adduction and abduction exercises
   • Straight-leg raises
   • Patellar mobilization

Phase II (Weeks 2-4)

1. Weightbearing: As tolerated
2. Range of Motion – Maintain full ROM; gentle passive stretching at end ranges
3. Therapeutic Exercises
   • Quadriceps and hamstring strengthening
   • Lunges
   • Wall-sits
   • Balance exercises – core work

Phase III (Weeks 4-6)

1. Weightbearing: Full weightbearing
2. Range of Motion – Full / painless ROM
3. Therapeutic Exercises
   • Leg press
   • Hamstring curls
   • Squats
   • Plyometric exercises
   • Endurance work
   • Return to athletic activity as tolerated

Phase I (Weeks 0-6)

1. Sling immobilization for first 6 weeks – out of sling to do home exercise program (pendulums) twice daily
2. Therapeutic Exercise
   • Grip Strengthening
   • Elbow / Wrist / Hand Exercises
   • Teach Home Exercises — Pendulums
3. Heat / Ice before and after PT sessions

Phase II (Weeks 6-12)

1. Discontinue sling
2. Range of Motion – PROM → AAROM → AROM, increase as tolerated
   • Begin Active Internal Rotation and Backward Extension as tolerated
   • Goals: >90° Forward Flexion and 30° External Rotation
3. Therapeutic Exercise
   • Begin light resisted exercises for Forward Flexion, External Rotation and Abduction – isometrics and bands – concentric motions only
   • No Resisted Internal Rotation, Backward Extension or Scapular Retraction
4. Modalities per PT discretion

Phase III (Months 3-12)

1. Range of Motion – Progress to full AROM without discomfort; gentle passive stretching at end range
2. Therapeutic Exercise
   • Begin resisted Internal Rotation and Backward Extension exercises
   • Advance strengthening as tolerated – Rotator Cuff, Deltoid and Scapular Stabilizers
   • Begin eccentric motions, plyometrics and closed-chain exercises
3. Modalities per PT discretion

Phase I (Weeks 0-6)

1. Weightbearing: As tolerated with crutches
2. Hinged Knee Brace
   • Worn for 4 weeks post-op
   • Locked in full extension for ambulation and sleeping – remove for hygiene and PT (Weeks 0–2)
   • Unlocked for ambulation and removed while sleeping, for hygiene and PT (Weeks 2–4)
3. Range of Motion – AAROM → AROM as tolerated
   • Weeks 0–4: Full ROM – no weightbearing at flexion angles greater than 90°
   • Weeks 4–6: Full ROM as tolerated – progress to flexion angles greater than 90°
4. Therapeutic Exercises
   • Quad / Hamstring sets, heel slides, straight leg raises, co-contractions
   • Isometric abduction and adduction exercises
   • Patellar mobilizations
   • At 4 weeks: Begin partial wall-sits – keep knee flexion angle less than 90°

Phase II (Weeks 6-12)

1. Weightbearing: As tolerated — discontinue crutch use at 6 weeks
2. Hinged Knee Brace: Discontinue brace use when patient has achieved full extension with no evidence of extension lag
3. Range of Motion – Full active ROM
4. Therapeutic Exercises
   • Closed-chain extension exercises, hamstring strengthening
   • Lunges – 0–90°, leg press – 0–90°
   • Proprioception exercises
   • Begin use of the stationary bicycle

Phase III (Weeks 12-16)

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

Phase IV (Months 4-6)

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

Comments

• Patients should avoid tibial rotation for 4–6 weeks post-op

Phase I (Weeks 0-8)

1. Weightbearing: Touchdown weightbearing (20–30% of body weight max) for 6–8 weeks – no bracing required
2. 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 level of flexion that is comfortable
   • Advance 10° per day until full flexion is achieved
   • Passive range of motion and stretching under guidance of PT
3. Therapeutic Exercises
   • Quadriceps / Hamstring isometrics
   • Heel slides

Phase II (Weeks 8-12)

1. Weightbearing: Advance to full weightbearing as tolerated — discontinue crutch use
2. Range of Motion – Advance to full / painless ROM
3. Therapeutic Exercises
   • 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