Rehabilitation Plan: 24 Weeks (6 month)

Patient: Relatively in shape (mid 40s)

Preoperative Stage: Goals: 1. Control Pain and swelling

2. Restore normal range of motion
3. Develop muscle strength sufficient for normal gait (walk)
4. Prepare patient mentally for surgery and introduce
rehabilitation plan

Immobilize the Knee: Patient should use a knee immobilizer such as a crutch or knee brace
(preferred). Brace should be worn when walking, but not over extended periods of time to avoid
quadricep atrophy, or quadricep weakness.

Control Pain and Swelling: Use an ice pad or nonsteroidal anti-inflammatory medications such
as Advial, Motrin, Aleve, or Ibuprofen to help control pain and swelling that may occur.

Restoring Normal Range of Motion: Performing quadricep exercises, straight leg raises, and
rage of motion exercises help to achieve full range of motion prior to the surgery
Exercises:
● Heel Props:
○ Place the heel on a rolled towel or foam roller making sure the heel is propped up
high enough to lift off the table
○ Allow the leg to relax when extending
○ Perform exercise 3-4 times per day for 10-15 minutes

● Prone Hang Exercise

○ Lie face down on a table with legs hanging off the edge of the table
 ○ Allow legs to relax into full extension

● Heel Slides
○ Used to gain increases degrees of flexion of knee
○ Pull the heel toward the buttocks, flexing the knee. Hold for 5 seconds
○ Straighten the leg by sliding the heel downward. Hold for 5 second

● Stationary Bicycle
○ Develops muscle strength in quadriceps
○ Use stationary bike two times a day for 10-20 minutes to increase muscular
strength, endurance, and maintain range of motion in knee
Immediately Following Surgery: Wear knee immobilizer while walking and sleeping. Can take
off the knee immobilizer brace during therapy and bathing. Following surgery, the leg will be
wrapped in cotton bandage and ace wrap will be applied over the cotton bandage to control
swelling in the leg. Take moderate doses of anti-inflammatory drugs such as Ibuprofen, Advil, or
Motrin to control the pain and inflammation.

Postoperative Week 1:

Goals: 1. Control pain and swelling

2. Care for knee
3. Range of motion exercises (easier)
4. Achieve and maintain full passive extension (movement achieved by therapist)
5. Engage quadricep muscles to prevent atrophy

Control Pain and Swelling: Following guidelines of I.C.E, ice, compress, and elevate the knee.
Try to keep the knee in an elevated position at most times during the day. Do not sit for extended
periods of time as this will cause increased swelling in the knee. Use anti-inflammatory drugs in
small doses if inflammation occurs. One adult aspirin is recommended twice per day to decrease
the risk of blood clots in the knee.

Caring for Knee: May need to change bandages as the original bandages may become bloody as
the blood drains out of the knee, rather than building-up, and causing swelling and pain. Wear
knee immobilizer when walking and sleeping.

Stretches: Stretch hamstrings and quadriceps to prevent inflammation to the area. Perform these
stretches once per day.

Exercises:
● Active-Assisted Extension
○ Performed by using the opposite leg and quadricep muscles to straighten the knee
from the 90 degree position to the 0 degree position
○ Should be performed 4 to 6 times a day for 10 minutes
● Passive bending, or flexion of the knee to the 90 degree position
○ Sit on the edge of a bed or table, and gently bend the knee
○ The opposite leg is used to support/control the amount of bending in the knee
○ Performed 4 to 6 times a day for 10 minutes

● Active Straight leg raises

○ Sit on the edge of a table or bed, with your leg in the 90 degree position
○ Gently extend knee while actively engaging the quad muscle
○ Lie on your back with legs flat on the table or bed
○ Move leg in the upward motion while keeping the knee is a straight position
○ Perform 4 to 6 times a day for 10 minutes
Suture Removal: Near the end of the 1 week period, a physical therapist can begin to remove
the sutures from the surgery. Important to remember to continue to remove the leg from the knee
immobilizer 4 to 6 times a day for 10-15 minutes at home to maintain full knee extension.

Postoperative Week 2

Goals: 1. Maintain full knee extension

2. Develop enough muscular control to limit use of knee immobilizer
3. Achieve 100-120 degrees of knee flexion
4. Control swelling in the knee

Maintain Full Extension of Knee: Continue with full passive extension, active flexion, active-
assisted extension, quadriceps isometrics, and the straight leg raise. Knee flexion should reach
90-100 degrees.

Exercises to Develop Muscle Control:

● Partial Squats
○ Place feet at shoulder width in a slightly externally rotated position
○ Use a table for stability, and gently lower the buttocks backward and downward
○ Hold for 6 seconds and repeat
○ Perform 3 sets of 10 each day

● Toe Raises
○ Using a table or chair, slowly raise the heel of the foot off the floor and balance
on the ball of the feet
○ Hold for 6 seconds and slowly move foot back down
○ Perform 3 sets of 10 each day
 ● Stationary Bicycle
○ Develops muscle strength in quadriceps
○ Can use when patient can bend their knee at least 100 degrees
○ Use stationary bike two times a day for 10-20 minutes to increase muscular
strength, endurance, and maintain range of motion in knee

Knee Immobilizer Brace: Patient should start to use knee immobilizer less if they have shown
good muscle control of the leg. Should instead use a crutch to walk as an alternative to the knee
brace. When walking with a crutch, it is important to maintain proper gait (walk) to maintain
range of motion.