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Protocol:

NOTE: Time frames below are provided for reference, but should not be used as criteria to progress each patient to the subsequent phase of rehabilitation. A decision to progress each patient to the next phase should be made solely on the ability to demonstrate the noted progression criteria within each phase.

WEIGHT BEARING PROTOCOL

Week 0-4: NWB
Week 4-6: TDWB
Week 6-12: If MD clears following XR, should be PWB progression to FWB

PLEASE DO NOT ADVANCE WEIGHT BEARING UNTIL SEEN IN THE OFFICE FOR VISITS

ACUTE PHASE (post-op weeks 0-6)

Weight Bearing Restrictions: TDWB
ROM: Full ROM without limitations
Modalities: As needed to assist with muscle activation, effusion control and pain management
PRE: Progression of acute phase strengthening to include initiation and progression of closed kinetic chain exercises within guidelines of WB restrictions

Criteria to progress to Sub-Acute Phase:
1. ROM = WNL
2. Can execute supine SLR w/o extensor lag
3. No effusion and pain with exercise

NEUROMUSCULAR STRENGTHENING PHASE (post-op weeks 6-12)

Weight Bearing Phase: Progression to FWB as tolerated (TDWB to PWB to FWB recommended over 1-2 wks)
ROM: No restrictions
Modalities: PRN
PRE: Progression of sub-acute strengthening to include FWB closed kinetic chain interventions

Criteria to Progress to Return to Activity Phase
1. ROM WNL
2. No residual pain or effusion with activity
3. Quadriceps strength deficit less than 20% of contralateral limb

RETURN TO ACTIVITY (when healing achieved)

Strengthening: Continue with a progression of NM strengthening PRE’s
Agility: Initiate agility, jogging and light impact activities in conjunction with return to activity goals. Progress to plyometric activities consistent with return to sport goals

Criteria to Progress to Sports/Activity:
1. Quadriceps strength within 10% of contralateral limb
2. Performance on functional hop testing within 10% of contralateral limb
3. Successful completion of a return to activity/function progression.