Meet Our Physicians       Patient Education       Patient Registration       Post-Op Instructions       Special Precautions       Rehab Protocols       Links of Interest	Planning for Surgery Rehabilitation Protocol: PATELLAR AND QUADRICEPS TENDON REPAIR PREOPERATIVE PHYSICAL THERAPY: If appropriate Preoperative orientation visit, review protocol Gait train on crutches/walker Instruction in home exercise program (SLR, Quad sets, short are quads, ankle pumps, and heel slides) Instruction in ROM exercises, patellar mobilization, and proper icing techniques. Schedule first post-op physical therapy visit beginning 7-10 days after surgery. OUTPATIENT PHYSICAL THERAPY: Phase 1: Immediately post-op to 2 weeks Goals: To protect the repair, decrease effects of immobilization, control inflammation, normalize gait pattern, and achieve quads control, and full extension. Brace: Locked in full extension during sleep and ambulation. May unlock brace while seated or supine for ROM. Will typically be worn for 6-8 weeks. Weight-bearing status: Limited to 5-10 lbs on operative side. Use crutches or walker for ambulation. Therapeutic exercises: SLR (in supine, prone, and side-lying positions) with brace locked in full extension Active gravity resistance hamstring curls 0º to 90º Light patellar massage Quad-sets at full extension with EMS or biofeedback Ankle pumps with elevation Prone hangs Heel slides Non-weight bearing calf and hamstring stretches Seated/supine assisted flexion hangs 0º to 90º Upper body cycling NO ACTIVE EXTENSION Phase 2: 2 to 6 weeks post-op Goals: Restore normal gait, full extension, increase flexion, protect repair, improve strength, endurance, and proprioception. Brace: Locked in full extension during sleep and ambulation. Weight-bearing status: Progress to WBAT. Discontinue crutches or walker when gait is normalized, unless otherwise instructed. Therapeutic exercises: Continue patellar massage as needed Heel slides Continue prone hangs with progressive weights Single-leg stance in brace locked in full extension Seated and standing toe-raises Progress to weight bearing calf and hamstring stretches Begin stationary bike with high seat and pedaling with non-operative leg only Continue hamstring curls with progressive weights Use EMS or biofeedback as indicated Continue upper body cycling NO ACTIVE EXTENSION Phase 3: 6 weeks to 3 months Goals: To improve confidence in the knee, avoid overstressing the repair, protect the patellofemoral joint, progress strength, power, and proprioception. Brace: Progress to ambulation without brace if cleared by doctor. May be discontinued if ROM is >90º and adequate motor strength is obtained. Therapeutic exercises: Begin active extension Continue progressive weight hamstring curls Continue flexibility exercises as appropriate for the patient Continue upper and lower body cycling Cross-country ski machine or elliptical stepper at 8 weeks Proprioception training (BAPS board) at 8 weeks if strength is adequate Lateral step-ups 1-2" at 8 weeks Wall sits to 70º, mini squats to 45º at 8 weeks Begin pool jogging/swimming in water vest at 8 weeks Lateral slide board at 10 weeks Begin straight ahead jogging at 10 weeks (if full ROM and no effusion) Add lunges if no PF issues at 10 weeks Continue lateral step-ups (progress to 4-8" blocks) at 10 weeks Begin closed chain strengthening (one legged squats, leg press 0º to 60º) at 10 weeks Add sport-specific activities (1/4 to ½ speed) at 3 months To begin after 3 months: Crossovers Lateral steps 1-2 feet Continue proprioception work Progress sport-specific activities to full speed at 4 months Return to sports or strenuous activities after 6 months if cleared by physician.