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°

Phase I (Weeks 0-2)

1. Weightbearing: Non-weightbearing using crutches
2. Brace: Patient in plantarflexion splint
3. No formal PT

Phase II (Weeks 2-6)

1. Weightbearing: As tolerated in CAM Walker Boot with heel wedges in place (first wedge removed at 4 weeks, second wedge removed at 6 weeks); discontinue crutch use
2. Brace: CAM Walker Boot at all times except showering and when working with PT
3. Range of Motion
   • PROM / AROM / AAROM of the ankle from full plantarflexion to neutral (no dorsiflexion past neutral)
   • Inversion / eversion
   • Toe flexion / extension
4. Therapeutic Exercises
   • Seated heel raises
   • Isometric dorsiflexion to neutral
   • Resistance bands for plantarflexion, inversion, and eversion
   • Proprioception exercises – single-leg stance with front support to avoid excessive dorsiflexion
   • Soft tissue mobilization, scar massage, desensitization, and edema control

Phase III (Weeks 6-12)

1. Weightbearing: Full weightbearing in sneaker
2. Range of Motion
   • PROM / AROM / AAROM of the ankle with progressive dorsiflexion
   • Increase dorsiflexion in 10° intervals
   • 10° by post-op week 8, 20° by week 10, 30° by week 12
3. Therapeutic Exercises
   • Standing heel raises
   • Single-leg eccentric lowering
   • Step-ups and side steps
   • Proprioception exercises – balance board

Phase IV (Months 3-6)

1. Progress strengthening, proprioception, and gait training activities
2. Begin light jogging at 12–14 weeks
3. Running and cutting at 16 weeks
4. Return to sports at 5–6 months

Phase I (Weeks 4-10)

1. Weightbearing: As tolerated in the hinged knee brace locked in extension
2. Hinged Knee Brace
   • Progressive increase in flexion allowed under guidance of PT
   • Week 4: 0–30°
   • Week 5: 0–40°
   • Week 6: 0–70°
   • Week 8: 0–90°
   • Week 10: Unlocked
3. Range of Motion – PROM and AAROM as tolerated according to restrictions above
4. Therapeutic Exercise
   • Begin isometric quadriceps strengthening and straight-leg raises
   • Patellar mobilization and scar massage

Phase II (Weeks 10-16)

1. Weightbearing: As tolerated — in unlocked hinged knee brace until week 12
2. Hinged Knee Brace
   • Completely unlocked for Weeks 10–12
   • Discontinue brace at Week 12 if patient can perform straight-leg raise with good quad control
3. Range of Motion – AAROM → AROM as tolerated
   • Goal: Full flexion by weeks 12–14
4. Therapeutic Exercise
   • Continue patellar mobilizations
   • Start stationary bicycle when ROM allows
   • Aquatic therapy
   • Begin progressive resistance exercises and therabands

Phase III (Months 4-6)

1. Weightbearing: As tolerated
2. Range of Motion – Full and painless
3. Therapeutic Exercise
   • Continue quadriceps strengthening
   • Focus on single-leg strength
   • Start treadmill walking and progress to light jogging at month 6

Phase IV (Months 6-12)

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

Phase I (Weeks 0-4)

1. Sling immobilization at all times except for showering and rehab under guidance of PT.
2. Range of Motion – PROM -> AAROM -> AROM as tolerated.
   • Restrict motion to 90° of Forward Flexion, 45° of Abduction, 30° of External Rotation and Internal Rotation to stomach.
3. Therapeutic Exercise
   • Elbow/Wrist/Hand Range of Motion.
   • Grip Strengthening.
   • Isometric Abduction, Internal/External Rotation exercises with elbow at side.
4. Heat/Ice before and after PT sessions.

Phase II (Weeks 4-6)

1. Discontinue sling immobilization.
2. Range of Motion – Increase Forward Flexion, Internal/External Rotation to full motion as tolerated.
3. Therapeutic Exercise
   • Advance isometrics from Phase I to use of a theraband within AROM limitations.
   • Continue with Elbow/Wrist/Hand Range of Motion and Grip Strengthening.
   • Begin Prone Extensions and Scapular Stabilizing Exercises (traps/rhomboids/levator scapula).
   • Gentle joint mobilization.
4. Modalities per PT discretion.

Phase III (Weeks 6-12)

1. Range of Motion – Progress to full AROM without discomfort.
2. Therapeutic Exercise
   • Advance theraband exercises to light weights (1-5 lbs).
   • 8-12 repetitions / 2-3 sets for Rotator Cuff, Deltoid and Scapular Stabilizers.
   • Continue and progress with Phase II exercises.
   • Begin UE ergometer.
3. Modalities per PT discretion.

Phase IV (Months 3-6)

1. Range of Motion – Full without discomfort.
2. Therapeutic Exercise
   • Advance exercises in Phase III (strengthening 3x per week).
   • Sport/Work specific rehabilitation.
   • Return to throwing at 4.5 months.
   • Return to sports at 6 months if approved.
3. Modalities per PT discretion.