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PHASE I – MAXIMUM PROTECTION (0 TO 1 WEEK):
- Ice and modalities to reduce pain and inflammation
- Use crutches non-weight bearing for 6 weeks
- Elevate the knee above the heart for the first 3 to 5 days
- Initiate patella mobility drills
- Full passive/active knee range of motion exercises
- Quadriceps setting focusing on VMO restoration
- Multi-plane open kinetic chain straight leg raising
- Gait training with crutches (Non- Weightbearing if large lesion )>2cm2, weightier as tolerated if small lesion.
PHASE II – PROGRESSIVE STRETCHING AND EARLY STRENGTHENING (WEEKS 1 TO 6):
- Patella mobility and scar massage
- Initiate global lower extremity stretching program
- Stationary bike and deep water pool exercise program (when incisions healed)
- Implement reintegration exercises emphasizing core stability
- Multi-plane ankle strengthening
WEEKS 8 TO 12:
- Normalize gait pattern
- Advance stationary bike program; begin treadmill walking and elliptical trainer; avoid running and impact activity
- Initiate closed kinetic chain exercises progressing from bilateral to unilateral
- Initiate proprioception training
PHASE IV – ADVANCED STRENGTHENING AND INITIATION OF PLYOMETRIC DRILLS (WEEKS 12 TO 20):
- Initiate gym strengthening-beginning bilateral progressing to unilateral
- Linear walking
- Swimming
- Bike outside light gearing
PHASE V – RETURN TO SPORT FUNCTIONAL PROGRAM (WEEKS 20 TO 24):
- Pool running with progression to dry land
- Linear drill with gradual progression to lateral and rotational as tolerated
- Bilateral plyometric activity progressing to unilateral as tolerated
- Continue with aggressive lower extremity strengthening, cardiovascular training, and flexibility
- Sports test for return to play – 6 to 9 months
