Rehabilitation Timeline After Surgery

Clinical Phase

• Lymphatic massage may be necessary to address edema in the first 2 weeks post-op.
• Patellar mobilization is important between 6-9 weeks post-op.
• ROM should progress to full extension between 12-18 weeks post-op.
• Weight shifting in different planes is crucial according to the surgical procedure.
• Breakdown of contracture in soft tissue is essential.
• Bike exercise can be started after 1 week if the patient can start.
• It is important to avoid arthrofibrosis, patello-femoral dysfunction, and hamstrings tendinosis.

Accelerated Program

• Post-op, electrical modalities should be used, with the leg at 0 degrees of extension.
• CPM is used until 90-110 degrees of flexion is reached.
• Bracing is discontinued if strength permits.
• CKC exercises, such as mini squats, one-legged mini squats, step-ups, toe raises, hamstring curls, and active assisted exercises progressing to AROM and RROM, are essential.

Weight-Bearing

• Full weight-bearing without crutches is achieved within 10 days, with a normal gait pattern.
• This improves quadriceps function, prevents patellofemoral pain, and does not affect knee stability.

Clinical Phase Considerations

• Release of the operated knee involves breaking the vicious circle of limitation, swelling, reflex spasm, soft tissue restrictions, pain, inhibited muscles, and proprioception feedforward to the brain.
• Considerations in the clinical phase include histological changes, healing process, social aspect, and surgical procedures.

Variations in Rehab Protocols

• Immobilization using a brace or splint is used for 0-2 months or 0-1 week, respectively.
• CPM is started within 0-1 week.
• ROM exercises are started within 0-1 week, with a goal of passive hyperextension to 90-115° flexion by 2 weeks.
• Partial weight-bearing is started immediately to 3 weeks, and full weight-bearing is started as tolerated (3 days) to 6 weeks.
• Jogging is started at 3-4 months, and full sporting activity is started at 4-9 months.

Criteria to Progress to Phase 2

• Knee effusion must be well controlled.
• Adequate quadriceps control must be demonstrated.
• Normal gait pattern without assistive devices must be achieved.
• Knee range of motion of at least 0-90° must be achieved.

Clinical Phase 2-6 Weeks

• The integration of the knee to the lower limb chain involves combined movement of hip and ankle (kinematic part).
• Transmission of load and reaction through the chain (kinetic part) is important.
• Optimization of the connection results in normal walking with symmetry of both sides.