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

Phase I (Weeks 0-6)

1. Sling immobilization at all times (in flexion, abduction and 0° of rotation) except for showering and rehab under guidance of PT
2. Range of Motion
   • Weeks 0–3: None
   • Weeks 3–6: Begin passive ROM – Restrict motion to 90° of Forward Flexion, 90° of Abduction, and 45° of Internal Rotation
3. Therapeutic Exercise
   • Elbow/Wrist/Hand Range of Motion
   • Grip Strengthening
   • Starting Week 3: Begin passive ROM activities – Codman’s, Anterior Capsule Mobilization
4. Heat/Ice before and after PT sessions

Phase II (Weeks 6-12)

1. Sling immobilization for comfort only
2. Range of Motion
   • Begin AAROM / AROM
   • Goals: 135° of Forward Flexion, 120° of Abduction, Full External Rotation
3. Therapeutic Exercise
   • Continue with Phase I exercises
   • Begin active-assisted exercises – Deltoid / Rotator Cuff Isometrics
   • Starting Week 8: Begin resistive exercises for Rotator Cuff, Scapular Stabilizers, Biceps and Triceps (keep all strengthening exercises below the horizontal plane during this phase – utilize exercise arcs that protect the posterior capsule from stress)
4. Modalities per PT discretion

Phase III (Weeks 12-16)

1. Range of Motion – Progress to full AROM without discomfort
2. Therapeutic Exercise
   • Advance Phase II exercises
   • Emphasize Glenohumeral Stabilization, External Rotation and Latissimus eccentrics
   • Begin UE ergometer / endurance activities
3. Modalities per PT discretion

Phase IV (Months 4-6)

1. Range of Motion – Full without discomfort
2. Therapeutic Exercise
   • Continue with strengthening
   • Sport / Work specific rehabilitation – Plyometric and Throwing / Racquet Program
   • Continue with endurance activities
   • Return to sports at 6 months if approved
3. Modalities per PT discretion

Phase I (Weeks 0-4)

1. Sling 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, 25° External Rotation in the 30° abducted position, 60–80° Abduction in the plane of the scapula without rotation, Limit Internal Rotation to 45° with the shoulder in the 30° 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 4-10)

1. Discontinue sling immobilization at 6 weeks post-op
2. Range of Motion
   • 4–6 weeks: PROM → Forward Flexion and Abduction to tolerance, 45° External Rotation in the 30° abducted position
   • 6–10 weeks: Begin AAROM → AROM as tolerated; ER/IR to tolerance
   • Goals: Forward Flexion / Abduction >155°, ER/IR >75° at 90° of shoulder abduction
3. Therapeutic Exercise
   • 4–6 weeks: Begin gentle AAROM exercises (supine position), gentle joint mobilizations (grades I and II), continue with Phase I exercises
   • 6–10 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 10-16)

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
   • Push up plus (wall, counter, knees on floor, floor)
3. Modalities per PT discretion

Phase IV (Months 4-6)

1. Range of Motion – Full without discomfort
2. Therapeutic Exercise
   • Advance strengthening as tolerated: isometrics → therabands → light weights
   • 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

Phase I (Weeks 0-4)

1. Sling immobilization to be worn at all times except for showering and rehab under guidance of PT
2. Range of Motion – PROM → AAROM → AROM of elbow as tolerated without resistance (allows biceps tendon to heal into new insertion on the humerus without being stressed), AROM of shoulder (no restriction)
   • Goals: full passive flexion/extension at elbow and full shoulder AROM
   • Encourage pronation/supination without resistance
   • Grip strengthening
3. Heat/Ice before and after PT sessions

Phase II (Weeks 4-12)

1. Discontinue sling immobilization
2. Range of Motion
   • Begin AROM of elbow with passive stretching at end ranges to maintain/increase elbow/biceps flexibility
3. Therapeutic Exercise
   • Begin light isometrics with arm at side for rotator cuff and deltoid – can advance to bands as tolerated
   • Begin light resistive biceps strengthening at 8 weeks
4. Modalities per PT discretion

Phase III (Months 3-6)

1. Range of Motion – Progress to full AROM of elbow without discomfort
2. Therapeutic Exercise
   • Continue and progress with Phase II exercises
   • Begin UE ergometer
   • Begin sport-specific rehabilitation
   • Return to throwing at 3 months
   • Throwing from a mound at 4.5 months
   • Return to sports at 6 months if approved
3. Modalities per PT discretion