After Quadriceps Tendon Repair Rehabilitation Protocol

Phase One- Maximum Protection (Weeks 0-6)

0    to 2 weeks

• Brace locked in full extension for 6 weeks
  FULL weight bearing in Splint
• Ice and modalities to reduce pain and inflammation
• Aggressive patella mobility
• Range of motion 0 degrees to 30 degrees flexion

Weeks 2 to 4

• Continue with aggressive patella mobility
• Range of motion 0 degrees to 30 degrees
• Heel slides and total knee extension with ankle on towel
• 4 way leg lifts with brace locked
• Static quads

Weeks 4 to 6

• Range of motion 0 degrees to 60 degrees
• Increase intensity with quadriceps strength and straight leg raises

Phase Two- Progressive Range of Motion and Early Strengthening (Weeks 6-12)

Weeks 6 to 8

• Full weight bearing
• Range of motion 0 degrees to 90 degrees
• Continue with swelling control and patella mobility
• Gradually progress to full range of motion
• Begin mutli-plane straight leg raising and closed kinetic chain strengthening program focusing on quality VMO function
• Initiate open kinetic chain progressing to closed kinetic chain multi-plane hip strengthening
• Normalize gait pattern
• Begin stationary bike
• Initiate pool program

Weeks 8 to 10

• Wean out of brace
• Continue with patella mobility
• Normalize gait pattern
• Restore full ROM
• Progress open and closed kinetic chain program from bilateral to unilateral
• Increase intensity on stationary bike
• Begin treadmill walking program forward and backward
• Begin elliptical trainer

Weeks 10 to 12

• Full ROM
• Terminal quadriceps stretching
• Advance unilateral open and closed kinetic chain strengthening
• Initiate core strengthening program

Phase Three- Progressive Strengthening (Weeks 12 to 16)

Weeks 12 to 16

• Advance open and closed kinetic chain strengthening
• Increase intensity on bike, treadmill, and elliptical trainer
• Increase difficulty and intensity on proprioception drills
• Begin gym strengthening: leg press, hamstring curls, ab/adduction; avoid lunges and knee extensions 
• Begin multi-directional functional core program

Phase Four- Advanced Strengthening and Functional Drills (Weeks 16 to 20)

 Weeks 16 to 20

• May begin leg extensions; 30 degrees to 0 degrees progressing to full ROM as patellofemoral arthrokinematics normalize
• Begin pool running program advancing to land as tolerated

Phase Five- Plyometric Drills and Return to Sport Phase (Weeks 20 to 24)

Weeks 20 to 24

• Advance gym strengthening
• Progress running/sprinting program
• Begin multi-directional field/court drills
• Begin bilateral progressing to unilateral plyometric drills
• Follow-up appointment with physician
• Sports test for return to competition