PT Resources

Patellar Realignment

SIMPLE MENISCUS REPAIR


WITH REPAIR OF THE MEDIAL PATELLOFEMORAL LIGAMENT

 


POST-OP REHABILITATION PROGRAM

 

General considerations:

  • -Patients are weight bearing as tolerated with crutch use as needed post-operatively.
  • -Range of motion will be blocked at 0 degrees in a knee immobilizer for 4 weeks. They will wean to a patellofemoral neoprene brace first for sleeping, then around their house, and finally with all ADL’s as soon as they are able to demonstrate adequate control of the lower extremity.
  • -Important not to push for flexion past 90 degrees for 8 weeks post-op to protect repair.
  • -Passive range of motion after the first 2 weeks once a day ONLY.
  • -Regular manual and self-mobilization of the patella (superior and inferior only), patella tendon, and portals should be performed to prevent fibrosis, improve range of motion, an functional mobility
  • -Regular attention to proper VMO recruitment and patellofemoral mechanics will optimize outcome.
  • *Return to sport and activities are dependent upon passing a functional, sports test.

Week 1:

  • -M.D. office visit at 1 day and 1 week post-op.
  • -Gait training, pain and edema control, and muscle stimulation to improve quadriceps recruitment.
  • -Ankle exercises, quad, adduction and gluteal sets, leg raises in multiple planes (except hip flexion).
  • -Extension stretching to hamstrings, calves, and lateral musculature to maintain extension range of motion.
  • -Well-leg stationary cycling and UBE. Upper body weight machines and trunk exercises.

Weeks 2 – 4:

  • -Continue to progress weight bearing and functional mobility as able
  • -Resistive band hip exercises (except flexion)
  • -Submaximal quad, gluteal and abduction/adduction isometrics within the range restrictions.
  • -Hip flexion leg raises when able to demonstrate no quadricep lag
  • -Calf raises, weight shifting, ankle exercises, balance and proprioception exercises.
  • -Patella, suprapatellar pouch and scar mobilization regularly.
  • -Pool walking and workouts as soon as incisions are well-healed.

Weeks 4 – 6:

  • -M.D. visit at 1 month post-op.
  • -Wean from immobilizer first with sleeping, then around the house.
  • -Submaximal quad isometrics and ankle isometrics through multiple ranges.
  • -Abduction, adduction and hip machines at the gym.
  • -Initiate weight shifting, short-arc knee bends and steps, and proprioceptive exercises within range.

Weeks 6 – 8:

  • -Functional exercises should focus on eccentrics. Increase depth of knee bends and add stepups as able to demonstrate good motion and control.
  • -Continue to increase intensity and resistance of other exercises.
  • -Passive flexion to 90 degrees for stretching.

Weeks 8-12:

  • -More aggressive passive flexion stretching to increase range of motion.
  • -Add lateral exercises (i.e. lateral stepping, lateral step-ups, etc.).
  • -Continue all exercises with emphasis on closed-chain, functional and proprioceptive program.
  • -Initiate two-legged stationary bicycling.
  • -Stair machine and Nordic Track in brace for cardiovascular.

Weeks 12-16:

  • -Goals are to increase strength, power, and cardiovascular conditioning.
  • -Sport-specific exercises and training program
  • -Maximal eccentric focused strengthening program
  • -Increase resistance of cycling, stair machine, and pool programs.

4-6 months:

  • -Goals are to develop maximal strength, power, and advance to sporting-simulation activities.
  • -Resisted closed-chain rehabilitation through multiple ranges.
  • -Begin light running program as able to demonstrate good strength and mechanics.

6-9 months:

  • -Running program, intensive balance drills and agility program.
  • -Initiate plyometric training as able to demonstrate adequate strength and proper mechanics.

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