1st Week After Surgery:
- Keep surgical dressing in place until follow up appointment and do not get wet
- Elevate operative extremity above the level of the heart as often as possible
- Apply ice to the operative knee for 20 minutes at a time at least five times a day
- Begin CPM machine the day after surgery
- Brace locked in extension at all times except when using CPM machine
- DVT prevention:
- 1 tablet 325 mg aspirin per day (obtain over the counter)
Phase I
0 to 6 Weeks
Main goals:
- Graft incorporation into native bone
- Early range of motion
Weightbearing/Brace:
- Weightbearing – heal touch
- Brace
- Weeks 0 – 2
- Worn in extension at all times except during strengthening exercises or CPM use
- Weeks 2 – 6
- Worn at all times but allow full flexion and extension
- Weeks 0 – 2
- Continuous Passive Motion (CPM) Machine
- Use 6 hours per day
- Start at 0° to 40°
- Increase 5° to 10° per day
- Goal on CPM is to be at 100° by Week 6
Exercises:
- Passive and active range of motion exercises as tolerated at 2 weeks post op
- Emphasis on strengthening and mobilization
Phase II
6 to 8 Weeks
Main Goals:
- Progress to full weightbearing
- Obtain full range of motion
Weightbearing:
- Initiated at 25% of weight
- Advance by 25% each week to full weightbearing
Range of Motion:
- Increased daily to goal of 130° of flexion
Exercises:
- Improve strength, flexibility, and neuromuscular control
- Initiate cardio
Phase III
8 – 12 Weeks
Main goals:
- Restore flexibility, strength, flexibility, and neuromuscular control
- Full pain-free range of motion
Exercises:
- Initiate gate training
- Closed chain exercises
- Initiate unilateral stance exercises
Phase IV
12 Weeks to 6 Months
Main Goals:
- Full, pain-free range of motion
- Normal gait with full weightbearing
Exercises:
- Advance strength training as tolerated
- Advance to single-leg curls and extensions by 14 to 16 weeks
Phase V
6 to 12 Months
Main Goals:
- Regain high levels of proprioception, strength, neuromuscular control, and flexibility
Exercises:
- Sport-specific training
Return to Play:
- Typically 6 – 8 months after surgery
- General criteria:
- Full active range of motion without apprehension
- Operative extremity within 10% of contralateral extremity on isokinetic testing
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