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Phase 1-Immobility and bracing

• Unlock brace to prescribed angles for range-of-motion exercises only on 1 and 2 post-op weeks
• Leave unlocked at 6 weeks post-op: extension stop 10 degrees and flexion stop 60 degrees
• Shower without brace on at 6 weeks post-op
• Sleep without brace on at 10 weeks post-op
• Use functional brace at 16 weeks post-op for ambulation and exercise until 52 weeks post-op; then exercise only
• Donjoy 4 point PCL brace or orthotist made brace

Phase 2-Range of motion

• Begin passive range of motion 1 week post-op from 0 degrees extension to 40 degrees flexion; increase 0 degrees extension and 10 degrees flexion per week beginning 6 weeks post-op for 2 weeks only, then lock at 10 degrees for 4 weeks
• May increase PROM prn
• Begin active range of motion 1 week post-op from 0 degrees extension to 40 degrees flexion; increase 0 degrees extension and 10 degrees flexion per week beginning 6 weeks post-op
• May increase AROM prn

Phase 3-Progressive weightbearing

• Begin weightbearing 12 weeks post-op; start with 25% body weight and increase 25% per week-then continue on one crutch (75% body weight) until notified.
• wean from crutches as tolerated-total 16 weeks on crutches

Phase 4-Isometrics

• Quad isometrics-spectrum isometrics
• Straight leg raises-may use weight up to 10 pounds
• Patella glides and tilts 3 times per day
• Neuromuscular stimulation-quadriceps 3 times/day
• Duration of 2 hours/session for 6 weeks until active quadriceps contraction

Phase 5-Isotonic progressive resistance exercises (PRE)

• Knee extension prohibited until 6 weeks post-op
• Knee flexion prohibited indefinitely
• Must wear brace during PRE’s-prone until 16 weeks post-op
• Knee extension PRE
• Increase prn from 0 degrees extension to 70 degrees flexion until 26 weeks post-op; then advance prn
• No limits on weight from 0 degrees extension to 40 degrees flexion

• Leg press PRE
• Increase prn from 0 degrees extension to 70 degrees flexion after 6 weeks post-op, then advance prn
• No limits on weight from 0 degrees extension to 40 degrees flexion

Phase 6-Functional exercises

• Start program 12 weeks post-op
• Restrict ROM to 10 degrees extension and 90 degrees flexion until 52 weeks post-op
• Mini squats-20 weeks post-op
• Sports cord-12 weeks post-op
• Tampoline-48 weeks post-op
• Balance board-26 weeks post-op
• Begin stationary cycling 12 weeks post-op; outdoor biking as soon as possible post-op
• Knee flexion at least 110 degrees
• Level ground only until 24 weeks post-op
• Begin swimming 8 weeks post-op (straight only)
• Pool jogging 36 weeks post-op
• Nordic Track-36 weeks post-op

Phase 7-Isokinetics

• Start low tibia sitting 36 weeks post-op
• ROM restriction; high speed performance from 0-90 degrees flexion
• Use patellar restraining brace-must wear functional brace (high speed only)