294 Knee Injuries

REHABILITATION PROTOCOL 4-8

After Arthroscopic Partial Medial or Lateral Meniscectomy
Phase 1: Acute Phase Phase 2
Goals Goals
Diminish inflammation and swelling. Restore and improve muscular strength and endurance.
Restore range of motion (ROM). Re-establish full nonpainful ROM.
Re-establish quadriceps muscle activity. Gradual return to functional activities.

Days 1–3 Days 10–17

Cryotherapy. Bicycle for motion and endurance.
Quadriceps sets. Lateral lunges.
Straight leg raise (SLR). Front lunges.
Electrical muscle stimulation to quadriceps. Half squats.
Hip adduction and abduction. Leg press.
Knee extension. Lateral step-ups.
30-degree mini-squats. Knee extension 90 to 40 degrees.
Active-assisted ROM stretching, emphasizing full knee Hamstring curls.
extension (flexion to tolerance). Hip abduction and adduction.
Weightbearing as tolerated (two crutches). Hip flexion and extension.
Light compression wrap. Toe raises.
Proprioceptive and balance training.
Days 4–7 Stretching exercises.
Cryotherapy. Active-assisted and passive ROM knee flexion (if necessary).
Electrical muscle stimulation to quadriceps. Elliptical trainer.
Quadriceps sets.
Day 17–Week 4
Knee extension 90 to 40 degrees.
Continue all exercises.
SLR.
Pool program (deep-water running and leg exercises).
Hip adduction and abduction.
Compression brace may be used during activities.
30 degree mini-squats.
Balance/proprioceptive drills. Phase 3: Advanced Activity Phase—Weeks 4–7*
Active-assisted and passive ROM exercises. Criteria for Progression to Phase 3
ROM 0 to 115 degrees (minimal). Full, nonpainful ROM.
Stretching (hamstrings, gastrosoleus, quadriceps). No pain or tenderness.
Weightbearing as tolerated (one crutch). Satisfactory isokinetic test.
Continued use of compression wrap or brace. Satisfactory clinical examination (minimal effusion).
High-voltage galvanic stimulation/cryotherapy. Goals
Enhance muscular strength and endurance.
Days 7–10 Maintain full ROM.
Continue all exercises. Return to sport/functional activities.
Leg press (light weight).
Exercises
Toe raises.
Continue to emphasize closed kinetic chain exercises.
Hamstring curls.
May begin plyometrics.
Bicycle (when ROM is 0–100 degrees with no swelling and
able to make a full revolution). Begin running program and agility drills.

*Patients can begin phase 3 when criteria are met, which may be earlier than week 4.
 After Lateral Retinacular Release 295

REHABILITATION PROTOCOL 4-9

Accelerated Rehabilitation After Meniscal Repair
D'Amato and Bach

Phase 1: Weeks 0–2 Therapeutic Exercises

Goals Closed kinetic chain resistance exercises 0 to
Full motion. 90 degrees.
No effusion. Bike and swim as tolerated.
Full weightbearing. Early-phase functional training.
Weightbearing Phase 3: Weeks 4–8
As tolerated. Criteria for Progression to Phase 3
Treatment Normal gait.
ROM as tolerated (0–90 degrees). Sufficient strength and proprioception for advanced
Cryotherapy. functional training.
Electrical stimulation as needed.
Isometric quadriceps sets. Goals
Straight leg raise (SLR). Strength and functional testing at least 85% of contralateral
side.
Phase 2: Weeks 2–4 Discharge from physical therapy to full activity.
Criteria for Progression to Phase 2
Full motion. Therapeutic Exercises
No effusion. Strength work as needed.
Full weightbearing. Sport-specific functional progression.
Goals Advanced-phase functional training.
Improved quadriceps strength.
Normal gait.

REHABILITATION PROTOCOL 4-10

After Lateral Retinacular Release
D'Amato and Bach

Indications for Lateral Release Ankle pumps.

Recalcitrant patellofemoral pain with a positive lateral tilt of Nonweightbearing gastrosoleus and hamstring exercises.
the patella (see page 266). Straight leg raise (SLR) in flexion with turnout, adduction, and
Tight lateral retinaculum—positive excessive lateral pressure extension; begin hip abduction at approximately 3 weeks.
syndrome. Functional electrical stimulation can be used for trace to
Lateral retinacular pain with positive lateral tilt. poor quadriceps contraction.
Begin aquatic therapy at 2 weeks (when wound is healed)
Phase 1: Immediately After Surgery–2 Weeks with emphasis on normalization of gait.
Goals Stationary bike for range of motion when sufficient knee
Protect healing soft tissue structures. flexion is present.
Improve knee flexion and extension. Phase 2: Weeks 2–4
Increase lower extremity strength, including quadriceps Criteria for Progression to Phase 2
muscle re-education.
Good quadriceps set.
Education of patient regarding limitations and rehabilitation
process. Approximately 90 degrees of active knee flexion.
Full active knee extension.
Weightbearing No signs of active inflammation.
As tolerated with two crutches. Goals
Therapeutic Exercises Increase flexion.
Quadriceps sets and isometric adduction with biofeedback Increase lower extremity strength and flexibility.
for vastus medialis obliquus. Restore normal gait.
Heel slides. Improve balance and proprioception.

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