Weight bearing Femoral Condyle

stage 1 – proliferative phase (0-6 weeks)

primary goals

Do not overload the graft site with compression forces
Increase Tibial Femoral and Patella Femoral Mobility
Restore Quadriceps Control
Proximal Hip Girdle Strengthening
Emphasize PROM to tolerance early

brace

  • Hinged brace with ambulation, until good quads control/SLR (approx 3-6 weeks)

weight bearing

  • Begin touch-down weight bearing for balance immediately
  • At 14 days begin 30% weight bearing – then increase to 60% at 4 weeks and maintain for 4 weeks
  • At approximately 8-10 weeks progress to 100% weight bearing

range of motion (rom)

  • Full Active Assisted ROM and gentle Active ROM
  • CPM
    • 6-8 hours per day – may/may not be broken into 2 hour segments
    • 0-60 degrees for 10 days
    • Then increase by 5 degree increments as tolerated to a goal of 90 degrees by 3 weeks
    • Remove the hinge while in CPM
  • Goal: Minimum 90 degrees flexion by 3 weeks, 110 degrees by 6 weeks, and full ROM by 12 weeks post-op

exercise therapy

  • Quad sets, SLR in hinge brace as needed including hip flexion, adduction, abduction and extension
  • Leg Curls, Heel slides
  • Stationary bicycle with no resistance once 90 degrees knee flexion obtained

physical therapy (the therapist)

  • Gentle multi-directional patella mobilization immediately after surgery
  • Passive Manual PROM by therapist: minimum 90 degrees flexion by 3 weeks, 110 degrees by 6 weeks, and full ROM by 12 weeks post-op – supine position
  • Cryotherapy and Ice Massage for swelling and pain control
  • E-stim for VMO/quadriceps muscle re-education/biofeedback encouraged early after surgery if needed
  • Gentle deep tissue and skin massage/deep friction to hamstring insertions, suprapateller quadriceps, medial/lateral gutters, and infrapatellar fat pad region 2-3 weeks after surgery
  • Whirlpool therapy recommended at 2-3 weeks post-op to enhance motion

comments

  • Contact physician if ROM not achieved to within 20 degrees of goal
  • No progression of this protocol until cleared by Physician at 6 weeks post-up

stage 2 – transitional phase – (7-12 weeks)

brace

  • Discontinue Hinge Brace with good quad control/independent SLR

gait

  • At 8-10 weeks, patient should be at full weight bearing with/without single crutch or cane

rom

  • Discontinue CPM
  • Continue AROM and PROM exercises

exercise therapy

  • Low weight leg curls for hamstrings
  • Stationary bicycle with gradual increased tension per level of comfort
  • Continue quad sets, SLR without brace, leg curls and heel slides
  • Strengthen quadriceps and hamstrings using ankle weights and/or elastic band resistance through full ROM as tolerated
  • Continue to strengthen hip girdle – abduction, adduction, flexion, extension – with straight leg raises with/without minimum weight

physical therapy (the therapist)

  • Continue gentle multi-directional patella mobilization as needed
  • Continue Manuel PROM by therapist: minimum 90 degrees flexion by 3 weeks, 110 degrees by 6 weeks, and full ROM by 12 weeks post-op
  • Cryotherapy for swelling and pain control
  • E-Stim for VMO/Quadriceps muscle re-education/bio-feedback as needed
  • Gentle massage/deep friction to hamstring insertions, suprapatellar quadriceps, medial/lateral gutters, and infrapatellar fat pad region
  • Whirlpool therapy (if available) to enhance motion

comments

  • Activity level should be modified if increased pain, catching or swelling occurs
  • No progression of this protocol until cleared by physician at 12 weeks post-op

stage 3 – remodeling phase – (13+ weeks)

brace

  • None

weight bearing

  • Full Weight Bearing

rom

  • Continue full AROM and PROM exercises
  • Discontinue CPM

exercise therapy

  • No leg extensions
  • No leg presses or half squats until 6 months
  • Bilateral leg presses and half squats at 6 months
  • Closed chain exercise to promote knee stability and proprioception through full ROM as tolerated
  • Cycling on level surfaces permitted with gradual increase in tension per level of comfort
  • Elliptical machine for strength and stamina
  • Treadmill use only after 6 months – walking only
  • Patient begin light jogging at 9 months on treadmill, not on concrete

physical therapy (the therapist)

  • Continue multi-directional patella mobilization as needed
  • Pool therapy (if available) to enhance ROM and quadriceps/hamstring muscle control
  • Cryotherapy for swelling and pain control
  • E-Stim for VMO/Quadriceps muscle re-education/bio-feedback as needed
  • Gentle massage/deep friction to hamstring insertions, suprapatellar quadriceps, medial/lateral gutters, and infrapatellar fat pad region

comments

  • Activity level should be modified if increased pain, catching or swelling occurs
  • Unilateral half squats and leg presses with progressive weights after 9 months
  • No pivoting sports should be done until after 12 months
  • May begin light straight line running/jogging after 9 months
  • Low weights with high repetitions


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