The SPORTS CENTRE L.L.C. Orthopedic Surgery, Sports Medicine, Fractures, Joint Replacement Rob O Connor M.D. www.sportscentreortho.com PATELLA/QUADRICEPS TENDON REPAIR REHABILITATION PROTOCOL
GENERAL POST-OPERATIVE INSTRUCTIONS: *This program is a guideline. Progression through the individual weeks/ phases will vary from patient to patient. Your physician and/or therapist will tell you if you are not making satisfactory progression through the program. It is important to follow the instructions and guidelines of your physician and therapist. Your repaired tendon has its own timetable for healing. This program is based on the stages of tendon healing and the timeline for tendon healing. No pain, good range of motion and good strength DOES NOT MEAN YOUR TENDON IS FULLY HEALED.! It will take 6-12 months for your tendon to heal. It will take 12-18 months to fully recover from this injury and surgery. Dressing Change Post operative day #3-5 and debulk Change once daily for two weeks Apply clean gauze, followed by ace wrap Shower May shower post operative day #10 No baths, pools or hot tubs for 3 weeks Sutures/Staples removed Post operative day #14 Cryo Cuff 20 minutes per hour Use after exercise or ambulation Swelling of knee may persist for 8-12 weeks Crutches Foot flat touch down weight bearing x 2 weeks Partial Weight Bearing 50% x 2 weeks WBAT Start Post operative Week # 4 Brace 8 weeks total Always on for ambulation! May be off at rest On when sleeping for first six weeks Off for shower/bathing May discontinue brace at 8 weeks if demonstrate appropriate quadriceps strength and control Physical Therapy Start post operative week one 2 times a week for 8-12 weeks Home exercise program As instructed by therapist! Medications/Pain Control Avoid Motrin and aleve if possible Studies suggesting these drugs may inhibit/delay tendon healing Week 0-2 Goals: Decrease Pain, Decrease Effusion, Full Passive Extension, Protect repair
Brace locked at 0 degrees for ambulation and exercise Foot flat touch down weight bearing With crutches Patella mobilizations Teach patient Calf Pumps Passive Extension Avoid hyperextension Heel Bolster/Prone Hangs E-Stim Standing Straight Leg Raise All Planes IN BRACE! Quad Sets Gluteal sets Heel Slides 0-30 degrees Week 2-4 Goals: No extensor lag, protect repair, 0-60 degree ROM Brace locked in 0 degrees of extension for ambulation 50 % Partial Weight Bearing With crutches Double leg heel raises in brace SLR all planes with brace Supine/prone/ Side Lying Hamstring Curls 0-45 degrees light resistance Heel slides to 60 degrees Start Proprioceptive Training: Double Leg BAPS with weight shift Single leg standing with parallel bars Week 4-6 Goals: Normal Gait, 0-90 degrees ROM Brace 0-45 degrees for ambulation Weight bearing as tolerated Wean off Crutches Continue Previous exercises Standing SLR with theraband in brace locked at 0 degrees Hamstring curls 0-90 degrees with light resistance Single leg heel raises out of brace if appropriate quadriceps control
Forward, lateral and retro step downs in brace locked at 0-45 degrees Week 6-8 Goals: Increase ROM, start progressive closed chain exercises Brace 0-70 degrees for ambulation Discontinue night time bracing Active knee extension against gravity No weight Straight leg raises on floor in all planes Light weight Leg Press 0-60 degrees Light resistance Mini squats Wall squats 0-60 Stationary Bike Gradual increase time and resistance Treadmill Forwards and backwards walking In brace Proprioceptive Training In brace Single Leg BAPS Ball toss Week 8-12 Goals: Full ROM, Increase strength and quad control D/C Brace at week 8 If appropriate quad control and strength Short arc quads Hamstring curls thru full ROM Leg Press 0-90 degree Light resistance Slider board Treadmill Walking progression program
Hip weight machine All planes Week 12 and forward Goals: Return to sport/activity/work, increase strength and function, Treadmill/jogging Running progression program Functional Activities Zig Zags Figure of eights Loops Quad and hip flexor stretches Transition to home program Return to sport or work Sports 4-6 months Depends on age, sport, activity level When cleared by Physician THE SPORTS CENTRE L.L.C. 151 STORRS ROAD MANSFIELD CENTER, CT 06250 (p)860-456-1780 (f)860-456-1976 WWW.SPORTSCENTREORTHO.COM