Authors

Prof Leo Pinczewski MBBS, FRACS

Dr Keran Sundaraj MBBS, MSc (Trauma), FRACS, FAOA

Dr Lucy Salmon BAppSc(Phty), PhD

Emma Fitzgibbon, BAppSc (Phty)

Contents

Stage 1 - weeks 1-2

Stage 2 - weeks 3-6

Stage 3 - weeks 6-12

Stage 4 - weeks 12+

Stage 1 - weeks 1-2

Aims

• Minimise Muscular atrophy

• Minimise swelling

• To achieve full range of motion as tolerated

• Minimise concurrent postoperative complications

Treatment Guidelines

• Static cocontraction exercises at full extension and 30 degrees knee flexion in neutral and internal hip rotation, with biofeedback if possible

• Reduction of swelling and pain using ice, elevation, co-contractions

• Active range of motion exercises to encourage ROM

• Commence use of stationary bike as soon as tolerated

• WBAT on crutches as required, instruction regarding same

• AVOID: Quadriceps exercises in external hip rotation, open chain quadriceps exercises, patellofemoral mobilisations, full weight bearing until sufficient muscular control

Stage 2 - weeks 3-6

Aims

• Regain muscular strength and flexibility

• Normalise gait

• Regain full ROM

Treatment Guidelines

• Progress cocontraction exercise to eccentric quadriceps in weight bearing positions,

• Gym equipment such as stationary bike, leg press to 45 degrees flexion, mini tramp with low resistance

• Soft tissue treatment to tight lateral structures, hamstrings and calf muscle

• Scar massage

• Commence full weight bearing with gait reeducation focusing on correct heel strike/toe off

• Active range of motion exercises to regain full range of motion

• AVOID: Quadriceps exercises in external hip rotation, open chain quadriceps exercises, patellofemoral mobilisations

Stage 3 - weeks 6-12

Aims

• Restoration of muscular strength and ROM

Treatment Guidelines

• Continue quadriceps and cocontraction exercises encouraging VMO activiation. Progress by

• increasing repetitions, length of contraction and dynamic conditions

• Full range of motion using active and passive techniques.

• Eccentric quadriceps exercises in external hip rotation may be commenced only after sufficent

• VMO strength to perform eccentric quads in neutral hip rotation from 10cm step, 10 reps X 3 sets

• without fatigue

• Commence stepper, rower and cross trainer, pool work once sufficient ROM and quadriceps control

• Commence prorioceptive and balance training eg wobble board

• Treat generalised lower limb deficits, e.g. gluteal control and flexibility, hamstrings flexibility, ITB, gastrocs and soleus, etc.

• AVOID: open chain quadriceps exercises, patellofemoral mobilisations

Stage 4 - weeks 12+

Aims

• Continuation of functional rehabilitation

Treatment Guidelines

• Progress co-contractions to more dynamic movements, e.g. step lunges, half squats, wall squats

• Patellofemoral taping should be introduced and continued for 1 year following surgery during sporting activities

• Introduce sport specific activities for strengthening and agility

• Start cycling on normal bicycle

• Progress resistance on gym equipment such as exercise bike, rower, cross trainer

• Pool work can include using flippers.

• AVOID: continue to avoid open chain quadriceps exercises which increase the patellofemoral joint forces