Kevin Sumida, MD

Post-op Program:

POD 1

1. Ankle pumps: 20-25 per hour
2. Strict NWB.  Brace locked in extension at all times unless performing exercises.
3. Gait with crutches
4. Patellar mobilizations
5. Polar care/ cryotherapy
6. Dressing change
7. Quad sets in brace

POW 1-6

1. Continue as above
2. Start SLR’s:  start standing, then sitting, then supine in brace
3. May use e-stim to promote quad recruitment
4. Encourage full extension
5. Progress ROM 10 deg per week beginning week 4 to achieve 90 deg by 8 weeks
6. Gait training with assistive device
7. Begin WBAT with brace locked in extension at 4 weeks
8. Start the following open chain exercises
   1. Side lying hip abduction and adduction
   2. Sitting hip flexion
   3. Ankle theraband
9. Encourage upper extremity strengthening for overall conditioning

POW 6-12

1. Continue as above
2. Be sure to advance knee to full ROM starting at 8 weeks
3. Unlock brace at 8 weeks to ambulate
4. D/C brace at 10 weeks
5. Aquatic therapy may start at 8 weeks for LE strengthening
6. Stationary bike with low resistance and seat up high to avoid hyperflexion
7. Standing terminal knee extension with theraband.
8. May increase resistance on stationary bike at 10 week

POW 12-16

1. Begin closed chain knee exercises
   ENCOURAGE PROPER TECHNIQUE AT ALL TIMES. 
   1. Single leg stance: level to unlevel surfaces
   2. Therakicks: progress resistance, speed, arc of motion
   3. Walking forward, retro, and sidestepping
   4. Standing calf raises, wobble board
   5. Wall slides
   6. Leg press with very light weights at 12 weeks
   7. Stationary bike
2. Jog Progression
1.  Fast walk
2. High knee march  
3.  Figure 8
4. 4 way reaction drill
5. Jog
6. Continue modalities
7. Encourage upper extremity strengthening for overall conditioning

POW 16-20

1. Continue as above
2. Progress exercises for building strength and endurance
   • 4-6 sets of 15-20 reps
   • Progress from double to single leg and concentric to eccentric
   • Emphasis on closed chain activities only
   1. Squats, leg press
   2. Lunges (front/side/back)
   3. Step-ups
   4. Leg curls
   5. Hip strengthening
   6. Resisted walking
3. Exercises for balance and proprioception
   • Progress from local to whole body
   1. Mini-tramp
   2. Sport cord
   3. Slide board
   4. Swiss ball
4. Exercises for endurance
   1. Bike
   2. Stairmaster
   3. Elliptical trainer
   4. Treadmill walking
   5. e.  Aquatic exercise

POW 20: Return to sport

1. Progress jump roping to line jumps, then box jumps, and then distance jumps
2. Begin sport specific drills
3. Progress speed and intensity of above activities

Return to Athletics Criteria

1. Satisfactory clinical exam
2. <10% isokinetic strength deficit (Leg Press)
3. Completion of sport replication activity
4. Single leg hop test