Patella Tendon Repair
Post-surgical Rehabilitation Protocol
The following is a protocol for post-operative patients following patella tendon repair. The primary goal of this
protocol is to protect the repair while steadily progressing towards and ultimately achieving pre-injury level of
activity. Please note this protocol is a guideline. Patients with additional surgery (i.e. collateral ligament repair,
meniscal repair) will progress at different rates. Achieving the criteria of each phase should be emphasized more
than the approximate duration. If a patient should develop an increase in pain or swelling or decrease in motion at
any time, activity should be decreased until problems are resolved.
Post-op Days 1 – 14
• Dressing:
- POD 1: Debulk dressing
- POD 2: Change dressing, keep wound covered
- POD 7-10: Sutures out, D/C TED hose when effusion resolved
• Brace x 8 weeks – Locked in extension for ambulation.
• Crutches – Partial weight bearing (PWB)
• Patella mobilization
• Calf pumping
• AAROM 0-45 degrees (passive extension, active flexion, heel slides)
• Passive extension with heel on bolster or prone hangs
• Electrical stimulation – sub-maximal quad sets for muscle re-education
• Quad sets, Co-contractions quads / hamstrings
• Standing straight leg raise (SLR) x 4 (in brace)
• Gentle hamstring stretch
• Ice pack with knee in full extension after exercise
Goals
• Full passive extension
• Good quad control
• Pain / effusion controlled
Weeks 2– 4
• Brace x8 weeks – Locked in extension for ambulation
• Crutches – Weight bearing as tolerated (WBAT), D/C when gait is normal
• Continue appropriate previous exercises
• AAROM 0-70 degrees (passive extension, active flexion)
• SLR x4 on mat (in brace)
• Hamstring curls 0-45 degrees on weight machine with light resistance
• Double leg heel raises
• Proprioceptive training (in brace)
- Single leg standing in parallel bars
- Double leg BAPS for weight shift
• Stretches – Hamstring , ITB
Matthew D. Collard, D.O.
Worker’s Compensation
Arthroscopy/Sports Medicine
Extremity Trauma
Joint Replacement Surgery
2325 Dougherty Ferry Rd, Ste. 100
St. Louis, MO 63122
(314) 909-1359 Fax (314) 909-1370
www.stlorthospecialists.com
2
Goals
• ROM 0 – 70 degrees
• No extensor lag
Weeks 4 - 6
• Brace x 8 weeks – Locked at 0-30 degrees for ambulation
• Continue appropriate previous exercises
• AAROM 0-90 degrees (passive extension, active flexion)
• Standing SLR x 4 (in brace) with Theraband bilaterally
• Hamstring curls 0-90 degrees on weight machine with light resistance
• Forward, lateral, and retro step downs in parallel bars (in brace 0-45 degrees)
- No knee flexion past 45 degrees (small step)
• Single leg heel raises (in or out of brace)
• Elliptical trainer (in brace)
Goals
• Normal gait
• ROM 0-90 degrees
Weeks 6 - 8
• Brace x 8 weeks – Gradually open to available range
• Continue appropriate previous exercises
• AAROM, AROM through full range
• Active knee extension without weight (no brace)
• SLR x4 on mat with light weight below the knee (no brace)
• Leg press 0-60 degrees – Light resistance (no brace)
• Mini squats, wall squats 0-60 degrees (no brace)
• Proprioceptive training (in brace) – Single leg BAPS, ball toss and body blade
• Stationary bike (no brace) – Progressive resistance and time
• Treadmill – Forwards and backwards walking (in brace)
• Pool therapy (flutter kicks from hip with knee in extension
Goal
• ROM 0-110 degrees
Weeks 8 - 12
• D/C brace
• Continue appropriate previous exercises and following ex without brace
• PROM, AAROM, AROM to regain full motion
• Short arc quads
• Hamstring curls on machine through full range – Light to moderate resistance
• Leg Press 0-90 degrees – Light to moderate resistance
• Hip weight machine x4 bilaterally
• Fitter
• Slide Board
• Treadmill – Walking progression program
Goals
• Full ROM
• Walk 2 miles at 15 min/mile pace
3
Months 3 – 4
• Continue appropriate previous exercises
• Knee extension weight machine with light to moderate resistance
• Functional activities – Figure 8’s, gentle loops, large zigzags
• Treadmill – Walking progressive program
Goals
• Equal thigh girth
• Equal quad flexibility in prone (heels to buttocks)
• Run 2 miles at easy pace
Months 4 – 6
• Continue appropriate previous exercises
• Agility drills / Plyometrics
• Sit-up progression
• Stairmaster
• Running progression to track
• Transition to home / gym program
Goal
• Return to all activities
*NO CONTACT SPORTS UNTIL 6 MONTHS POST-OP*
Revised 4/2019

Massachusetts General Brigham Sports Medicine

Rehabilitation Protocol for Patella/Quad Tendon Repairs
This protocol is intended to guide clinicians through the post-operative course for Patella/Quad Tendon repairs. This
protocol is time based (dependent on tissue healing) as well as criterion based. Specific intervention should be based on
the needs of the individual and should consider exam findings and clinical decision making. The timeframes for expected
outcomes contained within this guideline may vary based on surgeon’s preference, additional procedures performed,
and/or complications. If a clinician requires assistance in the progression of a post-operative patient, they should consult
with the referring surgeon.
The interventions included within this protocol are not intended to be an inclusive list. Therapeutic interventions should
be included and modified based on the progress of the patient and under the discretion of the clinician.
Considerations for the Post-operative Patella/Quad Tendon
Many different factors influence the post-operative patella/quad tendon rehabilitation outcomes, including tissue
quality and strength of repair. It is recommended that clinicians collaborate closely with the referring physician
regarding integrity of repair and any changes to protocol.
Post-operative considerations
Post-operative considerations If you develop a fever, intense calf pain, excessive drainage from the incision,
uncontrolled pain or any other symptoms you have concerns about you should call your doctor.
PHASE I: IMMEDIATE POST-OP (0-14 DAYS AFTER SURGERY)
Rehabilitation
Goals
• Protect repair
• Minimize post-operative pain
• Minimize post-operative edema
• Prevent complications from prolonged immobilization
• Prevent and recognize early signs of infection
Precautions • Hinged knee brace should be locked in extension and worn at all times (ambulating, sleeping,
standing, etc.)
• No active knee extension
• No passive knee flexion beyond 60 degrees- Do not push motion at this point
Weight Bearing • Weight Bearing as tolerated with hinged knee brace locked in extension
Intervention Swelling Management
• Ice, compression, elevation
• Retrograde massage
• Ankle pumps
Range of motion/Mobility
• PROM
• Heel slides with towel
• Low intensity, long duration extension stretches: prone hang, heel prop
• Seated hamstring/calf stretch
• Gentle patellafemoral joint mobilization
Strengthening
• Calf raises
• Quad sets
• Glute set
Massachusetts General Brigham Sports Medicine 2
Criteria to
Progress
• 2 weeks post-op
• Knee extension to 0 deg
PHASE II: INTERMEDIATE POST-OP (2-6 WEEKS AFTER SURGERY)
Rehabilitation
Goals
• Continued minimization of post-operative pain/edema
• Progress knee flexion PROM
• Progress to full weight bearing status with use of locked brace
• Initiate proximal/distal strengthening (hip, back, abdominals, ankle)
Weight Bearing • Weight Bearing as tolerated with hinged knee brace locked in extension, should be full weight
bearing by 6 weeks
Precautions • Knee flexion PROM starts at 50 degrees week 2
o Light overpressure only for PROM
• Progress 10 degrees/week until 90 degrees achieved
o 60 degree maximum end of week 2
o 70 degree maximum end of week 3
o 80 degree maximum end of week 4
o 90 degree maximum end of week 5
• Hinged brace locked in extension for standing/walking/sleeping
o Brace worn at night until week 6 unless otherwise specified by surgeon
o Can unlock for sitting/laying (brace angle can be unlocked to available PROM,
but not to exceed PROM progression noted above)
• Assistive device for ambulation as needed
Additional
Intervention
*Continue with
Phase I
interventions
Range of motion/Mobility
• Patellofemoral Joint Mobilization
• Gradual flexion PROM with light overpressure per above
• Extension PROM with overpressure as needed
• Heel Slide
• Sitting knee flexion to above ROM
• Heel prop
Cardio
• Upper body ergometer
Strengthening
• Straight leg raise *without lag
• Side lying hip abduction and adduction, prone leg extension
• Standing hip abduction, adduction and extension
• Glute bridge with legs straight elevated on a chair
• Calf raise
• Core strengthening: Plank as able without discomfort in knee, TA brace progression
Balance/proprioception
• Standing weight shifts
Criteria to
Progress
• Full passive knee extension PROM
• Passive knee flexion to 90 degrees
• FWB in brace with no pain
• Active knee extension to 0 degrees with quad set
PHASE III: LATE POST-OP (6-15 WEEKS AFTER SURGERY)
Rehabilitation
Goals
• Wean assistive devices if any are still used
• Restore full A/PROM of knee flexion
• Begin stationary bike when able
• Initiate progressive quadriceps loading/resistance exercises
• Restore static single leg balance
• Continue to progress proximal/distal strengthening
Massachusetts General Brigham Sports Medicine 3
Weight Bearing • Hinged brace unlocked for ambulation (0-60 degrees) provided patient demonstrates
sufficient quad control during stance to prevent buckling
o Use brace until week 8 unless otherwise specified by surgeon
o Patient should demonstrate sufficient quad control, weight bearing tolerance and single
limb stability prior to discharge of brace.
Precautions • No weight bearing with flexion >90 deg until after 8 weeks
• A/PROM should be cautioned not to progress faster than 10 degrees per week before 12 weeks
post-op
• Avoid aggressive quad stretching
• No maximal voluntary contraction of the quadriceps until week 16 (No manual muscle test or
handheld dynamometer testing).
Additional
Intervention
*Continue with
Phase I-II
Interventions
Range of motion/Mobility
• Patellofemoral Joint Mobilization
• Flexion PROM with overpressure
• Heel Slide
• Sitting knee flexion
Cardio
• Upper body ergometer
• Stationary bicycle- Begin with partial rotations minimal resistance and gradually progress time
and resistance once full motion is achieved.
• Elliptical- may begin once active knee flexion motion reaches at least 120 degrees, able to
perform 10 straight leg raises without lag, and gait is normalized without assistive device
Strengthening
*Progress strength gradually as appropriate avoiding anterior knee pain, many of the below exercises will
not begin until 8-10 weeks or later
• Gym equipment: leg press machine, seated hamstring curl machine and hamstring curl
machine, hip abductor and adductor machine, hip extension machine, roman chair, seated
calf machine
Progress intensity (strength) and duration (endurance) of exercises as appropriate
*The following exercises to focus on proper control with emphasis on good proximal stability
• Squat to chair
• Lateral lunges
• Romanian deadlift (single and double leg)
• Resisted triple extension in standing
• Single leg progression: partial weight bearing single leg press, step ups and step ups with
march, slide board lunges: retro and lateral, lateral step-ups, single leg squats, single leg wall
slides, lateral step down
o Knee Extension machine at 16 weeks: If quad strength continues to be significantly limited,
limiting further progression, may begin using knee extension machine as long as there is no
anterior knee discomfort or pain
• Proximal Strengthening: Double leg bridge, bridge with feet on physioball, single leg bridge,
lateral band walk, standing clamshell/fire hydrant, hamstring walkout, TA brace with UE and
LE progression
Balance/proprioception
• Progress single limb balance including perturbation training
Massachusetts General Brigham Sports Medicine 4
Criteria to
Progress
• Good recovery of quadriceps strength
o Ability to perform 10 single leg squats to 60 degrees
o Quad strength of at least 70% on handheld dynamometer: If following standard timeline,
and timeline not delayed due to integrity of repair, can test quad strength at week 16
o Or 100% quad set compared to contralateral side (measured by sphygmomanometer in
mmHg)1
• Knee flexion PROM to at least 120 degrees
• Single leg stance to 30 seconds on involved side with no significant compensatory pattern
• Symmetrical gait pattern without use of assistive device
• Symmetrical stair negotiation without reliance on UE
PHASE IV: TRANSITIONAL (4-6 MONTHS AFTER SURGERY)
Rehabilitation
Goals
• Restore full ROM and muscle length of quadriceps
• Restore quadriceps strength (quad index preferred)
• Restore single leg dynamic balance/eccentric control (Y balance preferred)
• Initiate return to jog/run protocol as tolerated
• Restore proximal/distal strength to symmetry with contralateral side
Precautions • Avoid pain more than delayed onset muscle soreness (DOMS) during or following exercise
especially in the anterior knee/extensor mechanism
Additional
Interventions
*Continue with
Phase I-III
interventions
• Begin sub-max sport specific training in the sagittal plane
• Bilateral PWB plyometrics progressed to FWB plyometrics
Progress to plyometric and agility program (with functional brace if prescribed)
• Agility and Plyometric Program
Interval running program
• Return to Running Program
• Must have full ROM, resolved swelling, no pain with walking, at least 80% limb
symmetry on handheld dynamometer, and ability to perform SL hop with good form
prior to initiating jogging progression
Criteria to
Progress
• Quad index of at least 90% (handheld dynamometry preferred, if not sphygmomanometer is
acceptable, but consider referring to clinic with dynamometry available for testing)
o Isokinetic dynamometry should be held until 6 months and reserved for cases where
advanced return to sport/activity is needed
• Symmetrical strength measures in hamstrings and hip (dynamometry preferred)
• Y balance test within 90% of contralateral side
• Symmetry in gait while jogging
PHASE V: PROGRESISVE RETURN TO SPORT (6-8 MONTHS AFTER SURGERY)
Rehabilitation
Goals
• Progress running/sprinting program
• Improve multidirectional dynamic movements and control of acceleration/deceleration
• Improve power in plyometrics and landing mechanics
• Restore full quadriceps strength
• Return to sport/competition with minimal risk of re-injury
Additional
Interventions
*Continue with
Phase II-IV
interventions
• Add sport specific exercises based on patient’s desired sport goals
o If participating in a cutting/sprinting sport, increased focus on rapid
acceleration/deceleration activities and change of direction drills gradually increasing
demand and predictability of drill
Criteria to
Progress
• Pass all criteria of the MGB Lower Extremity Return to Sport Functional Testing
• Quad index of at least 90% (measured by dynamometry, isokinetic preferred)
Revised 10/2021
Massachusetts General Brigham Sports Medicine 5
Contact Please email MGHSportsPhysicalTherapy@partners.org with questions specific to this protocol
References:
Mondin D, Owen JA, Negro M, D’Antona G. Validity and Reliability of a Non-invasive Test to Assess Quadriceps and Hamstrings Strength in Athletes. Front
Physiol. 2018;9:1702. doi:10.3389/fphys.2018.01702
Sinacore JA, Evans AM, Lynch BN, Joreitz RE, Irrgang JJ, Lynch AD. Diagnostic Accuracy of Handheld Dynamometry and 1-Repetition-Maximum Tests for
Identifying Meaningful Quadriceps Strength Asymmetries. J Orthop Sports Phys Ther. 2017;47(2):97-107. doi:10.2519/jospt.2017.6651
Seo D, Kim E, Fahs CA, Rossow L, Young K, Fergu SL. Reliability of the one-repetition maximum test based on muscle group and gender. :5.
Kongsgaard M, Reitelseder S, Pedersen TG, et al. Region specific patellar tendon hypertrophy in humans following resistance training. Acta Physiol.
2007;191(2):111-121.
Couppé C, Kongsgaard M, Aagaard P, et al. Habitual loading results in tendon hypertrophy and increased stiffness of the human patellar tendon. J Appl Physiol.
2008;105(3):805-810. doi:10.1152/japplphysiol.90361.2008
Verdano MA, Zanelli M, Aliani D, Corsini T, Pellegrini A, Ceccarelli F. Quadriceps tendon tear rupture in healthy patients treated with patellar drilling holes:
clinical and ultrasonographic analysis after 36 months of follow-up. :7.
Bhargava SP, Hynes MC, Dowell JK. Traumatic patella tendon rupture: early mobilisation following surgical repair. Injury. 2004;35(1):76-79.
doi:10.1016/S0020-1383(03)00069-X
13. Bushnell B, Tennant J, Rubright J, Creighton R. Repair of Patellar Tendon Rupture Using Suture Anchors. J Knee Surg. 2010;21(02):122-129. doi:10.1055/s0030-1247806
Mille F, Adam A, Aubry S, et al. Prospective multicentre study of the clinical and functional outcomes following quadriceps tendon repair with suture anchors.
Eur J Orthop Surg Traumatol. 2016;26(1):85-92. doi:10.1007/s00590-015-1710-6
EL-Zahaar, MS. Spontaneous Rupture of the Quadriceps Tendon: Ten Case Reports and a Review of the Literature with a Hypothesis of a New Classification of
Causes. J Nuerol Orthop Med Surg. 1995; 16: 132-136.
Puranik GS, Faraj A. Outcome of quadriceps tendon repair. Acta Orthop Belg. 2006;72:3.
Veselko M, Kastelec M. Inferior Patellar Pole Avulsion Fractures: Osteosynthesis Compared with Pole Resection. JBJS Essent Surg Tech. 2005;os87(1_suppl_1):113-121. doi:10.2106/JBJS.D.02631
El-Desouky I, Mohamed M, Al Assassi M. Primary Repair of Ruptured Patellar Tendon Augmented by Semitendinosus. J Knee Surg. 2013;27(03):207-214.
doi:10.1055/s-0033-1360655
Reidler, J. S., Tanaka, M. J., & Cosgarea, A. J. (2018). Quadriceps tendon repair. In Operative Techniques: Knee Surgery: Second Edition (pp. 254-261). Elsevier
Inc.. https://doi.org/10.1016/B978-0-323-46292-1.00027-7
Marder RA, Timmerman LA. Primary Repair of Patellar Tendon Rupture Without Augmentation. Am J Sports Med. 1999;27(3):304-307.
doi:10.1177/03635465990270030601
Belhaj K, El Hyaoui H, Tahir A, et al. Long-term functional outcomes after primary surgical repair of acute and chronic patellar tendon rupture: Series of 25
patients. Ann Phys Rehabil Med. 2017;60(4):244-248. doi:10.1016/j.rehab.2016.10.003
Langenhan R, Baumann M, Ricart P, et al. Postoperative functional rehabilitation after repair of quadriceps tendon ruptures: a comparison of two different
protocols. Knee Surg Sports Traumatol Arthrosc Off ESSKA. 2012;20(11):2275-2278. doi:10.1007/s00167-012-1887-8
Konrath GA, Chen D, Lock T, et al. Outcomes following repair of quadriceps tendon ruptures. J Orthop Trauma. 1998;12(4):273-279. doi:10.1097/00005131-
199805000-00010
Serino J, Mohamadi A, Orman S, et al. Comparison of adverse events and postoperative mobilization following knee extensor mechanism rupture repair: A
systematic review and network meta-analysis. Injury. 2017;48(12):2793-2799. doi:10.1016/j.injury.2017.10.013
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2008;36(2):316-323. doi:10.1177/0363546507308192

This work was supported by the Uniformed Services University, Department of Physical Medicine & Rehabilitation,
Musculoskeletal Injury Rehabilitation Research for Operational Readiness (MIRROR) (HU00011920011).
The opinions and assertions expressed herein are those of the author(s) and do not necessarily reflect the official policy or
position of the Uniformed Services University or the Department of Defense.
Tri-Service Post-Operative Rehabilitation Guidelines
May 2020
Approved by:
B. KYLE POTTER
COL, MC, USA
Army Orthopedics Consultant
GEORGE P. NANOS III
CAPT, MC, USN
Navy Orthopedics Consultant
JOSEPH J. STUART
Lt Col, USAF, MC
Air Force Orthopedics Consultant
JASON L. SILVERNAIL
COL, SP, USA
Army Physical Therapy Consultant
LESLIE C. HAIR
CDR, MSC, USN
Navy Physical Therapy Consultant
JAMES E. SHIELDS
Col, USAF, BSC
Air Force Physical Therapy Consultant

Created with support from:
Uniformed Services University of the
Health Sciences –
F. Edward Hébert School of Medicine
The Geneva Foundation Military Orthopaedics Tracking
Injuries and Outcomes Network
(MOTION)
Patellar Tendon Repair Rehabilitation
These guidelines were created as a framework for the post-operative rehabilitation program. They DO
NOT substitute for any specific restrictions or requirements that are determined through the necessary
shared decision-making and collaboration between the operating surgeon and treating rehabilitation
team.
PHASE 1: Generally 0-6 Weeks Post-Op
GOALS: 1) Protect surgical repair
2) Minimize pain and swelling
3) Activation of the quad muscle
4) ROM: 0°- 90°
PRECAUTIONS: - ROM
 Weeks 1-2: 0°- 30°
 Week 3: NWB, knee ROM 0°- 60°; progress by 10° each week
- Follow WB restrictions at discretion of Ortho
BRACE: - Wear brace locked in extension for ambulation
- May unlock or remove for rehab
WOUND: - Post-op dressing remains intact until post-op day #3 (~72 hours after
surgery)
- Shower after post-op day #4 (no need to cover incision site)
- DO NOT SUBMERGE knee in water until authorized to do so by Ortho
- Suture removal @ 10-14 days post-op per Ortho
CRYOTHERAPY: - Cold with compression/elevation (ice with compression wrap)
REHABILITATION: - Begin scar massage after incision has healed and scar is formed
- Begin patellar mobilizations
~Weeks 1-2 - Quad, glute and HS isometrics (submaximal contraction intensity); use estim if needed
- Multi-directional open chain hip muscle endurance exercises
- Calf pumps with theraband
- Heel slides (assisted as needed)
- Supine passive extension to 0°
~Weeks 3-6 - Continue exercises from weeks 1-2 as appropriate
- Gradually increase knee flexion to goal of 90 degrees by Week 6
- Multi-directional open chain hip muscle endurance exercises with
increased resistance
- Progressive PF strengthening
- Short arc quads
- General LE stretching
- Stationary bike within limits of ROM
- Beginner level pool exercises when incisions are fully healed; primarily in
the sagittal plane (i.e. no breaststroke or whip kick motion)
FOLLOW-UP: - Supervised rehab: 2-3x per week
- PT re-eval: every 1-2 weeks
- Ortho re-eval: ~2 and ~6 weeks
PHASE 2: Generally 7-12 Weeks Post-Op
GOALS: 1) Normal gait and stair ambulation
2) > 80% quad and HS strength relative to uninvolved limb
3) Full ROM
PRECAUTIONS: - Avoid tendon overload (i.e. squatting, deep knee bends, and lunges)
- Be careful walking up/down steps or inclined surfaces
- NO RUNNING
- NO PARTICIPATION in contact/collision sports or military schools
BRACE: - D/C brace & crutches when gait is normal and 120° knee flexion is
achieved
REHABILITATION: - Continue Phase 1 exercises as needed
- Progress to the following exercises and increase intensity gradually when
patient is ready (i.e. no increase in knee pain or effusion since the
previous exercise session)
~Weeks 7-8 - Stationary bicycle or elliptical for conditioning
- General LE strengthening with very gradual increase on loading of knee
extension exercises (i.e. squats, lunges, and leg press)
- Gait training as needed (i.e. cone walking, marching, retrowalking, and
cariocas)
- Forward, lateral, and retro step-ups (start with 2" step and progress as
tolerated)
- Continue beginner level pool exercises (i.e. no breaststroke or whip kick
motion)
~Weeks 9-10 - Continue progressing exercises from Weeks 7-8 as appropriate
- DL balance and proprioceptive exercises; progress to SL
- General LE stretching
- Elliptical: add gradually with stationary bike for conditioning
- Progressive LE strengthening (i.e. calf press, leg press, squats 0°- 45°, HS
curls, and hip abductors/adductors)
- Progressive pool program as tolerated
~Weeks 11-12 - Continue progressing exercises from Weeks 9-10 as appropriate
- Progress ROM of squats, leg press, etc. while being mindful of ROM
restrictions and pain
FOLLOW-UP: - Supervised rehab: 2-3x per week
- PT re-eval: every 2-3 weeks
- Ortho re-eval: ~12 weeks post-op
PHASE 3: Generally 3-6 Months Post-Op
GOALS: 1) Full ROM
2) Jog at own pace and distance without pain
3) > 90% quad and HS strength return
4) > 90% of uninvolved limb on hop test battery (i.e. hop for distance, triple
hop, crossover hop, and 6-meter timed hop)
5) Meet occupational requirements at 6-8 months
PRECAUTIONS: - Minimal to no pain at the repair site
REHABILITATION: - Continue Phase 2 exercises as needed
- Progress to the following exercises and increase intensity gradually when
patient is ready (i.e. no increase in knee pain or effusion since the
previous exercise session)
- Build up resistance and repetitions gradually
~Weeks 13-16 - Swimming
- Step-up progression
- Gradual quad stretching
- Progressive SL balance and proprioceptive training as needed
- Progressive LE strengthening (i.e. calf press, leg press, squats 0°- 60°, HS
curls, and hip abductors/adductors)
~Weeks 16-20 - Progressive strengthening of quads while monitoring symptoms closely
- Step-down progression
- Initiate walk to jog progression
~Weeks 20-26 - Progressive speed/agility training beginning at 25-50% intensity and
progress gradually (i.e. jumping, hopping, directional jogging, cariocas,
and shuffles)
- Jump training initiated after 24 weeks
FOLLOW-UP: - Supervised rehab: 1-2x per week
- PT re-eval: monthly
- Ortho re-eval: ~6 months post-op
MISCELLANEOUS: - After 6 months post-op, Phase 3 exercises are continued and gradually
increased in intensity and duration as tolerated
- Pass Service fitness test at 9-10 months
- Progress activities for return to sport/collision sports or aggressive
military training (i.e. airborne school) based on the patient’s functional
performance and endurance. This time period will be directed by the
Ortho Surgeon and the Physical Therapist. This may require between 9-12
months before cleared without restrictions.
References:
 Myer GD, Paterno MV, Ford KR, Quatman CE, Hewett TE. Rehabilitation after anterior cruciate
ligament reconstruction: criteria-based progression through the return-to-sport phase. Journal
of Orthopedic Sports Physical Therapy. 2006; 36(6): 385-402.
 Myer, GD, Paterno MV, Hewett TE. Back in the game: a four-phase return-to-sport program for
athletes with problem ACLs. Rehab Management. 2004; 17(8): 30-33.