knee- patellofemoral- arthroscopic anteromedial plica resection rehabilitation
This document is a detailed, clinician‑authored rehabilitation protocol from the Advanced Continuing Education Institute for patients who have undergone arthroscopic anteromedial plica resection of the knee. It begins with a list of postoperative precautions aimed at controlling capsular and synovial inflammation, preventing pain at the anteromedial knee, and avoiding deep squatting or resisted extension. The protocol is organized into four progressive phases spanning the first six months after surgery. Phase I (Weeks 1‑4) focuses on maximum protection, inflammation control, early passive range of motion (PROM), quadriceps activation, and basic isometric and closed‑kinetic‑chain (CKC) exercises, with detailed stage‑specific instructions for weight‑bearing, ice/compression, and ROM targets (e.g., 0‑115° by week 2, up to 0‑135° by week 4‑5). Phase II (Weeks 4‑8) advances to full PROM/AROM, pain‑free gait, and strength building through leg press, wall squats, step‑ups, balance/proprioception work, and aquatic therapy, while maintaining anti‑inflammatory measures. Phase III (Weeks 9‑14) emphasizes strength, endurance, and functional conditioning, adding treadmill walking, interval throwing/hitting, and progressive pool running, with specific week‑by‑week milestones. Phase IV (Months 4‑5) targets unrestricted activity and sport‑specific readiness, requiring full painless ROM, no tenderness, satisfactory clinical exam, and adequate muscular strength before initiating in‑field baseball drills, deep squatting, and comprehensive sport‑specific programs. Throughout, the protocol specifies progression criteria, exercise dosage, and safety cautions, providing clinicians a stepwise roadmap to safely return patients to full activity.
Topics
Post‑Surgical Precautions for Anteromedial Plica Resection
Key safety measures to control capsular and synovial inflammation, avoid pain at the anteromedial knee, and limit deep squatting or resisted extension during early healing.
Phase I – Maximum Protection (Weeks 1‑4): Early Healing and ROM Initiation
Stage 1 (Days 1‑10) and Stage 2 (Weeks 2‑4) protocols covering ice/compression, crutch use, passive ROM progression (0‑115° by week 2, up to 0‑135° by week 4‑5), quad activation, basic isometrics, CKC mini‑squats, and electrical muscle stimulation.
Phase I – Initial Exercise Program (Weeks 1‑3) and CKC Foundations
Specific multi‑angle isometrics, straight‑leg raises, wall squats, lunges, step‑downs, balance drills, bicycle, and early pool work designed to build neuromuscular control without provoking pain.
Phase II – Intermediate Phase (Weeks 4‑8): Strength, Gait Normalization, and Proprioception
Progression to full PROM/AROM (0‑135°), leg press, deeper knee extensions, hip ab/adduction, wall/vertical squats, step‑ups, hamstring curls, balance platforms, Biodex stability, pool running, elliptical, and adjunct laser therapy.
Phase III – Advanced Activity (Weeks 9‑14): Endurance, Functional Conditioning, and Sport‑Specific Initiation
Continuation of Phase II exercises, treadmill walking, interval throwing/hitting (weeks 12‑14), progressive pool running, and introduction of interval running program by week 14.
Phase IV – Return to Activity (Months 4‑5): Sports‑Specific Readiness and Unrestricted Activity
Criteria for progression (full painless ROM, no tenderness, satisfactory exam and strength), initiation of in‑field baseball drills, deep squatting, and comprehensive strengthening and stretching regimen.
Progression Criteria and Milestones Across All Phases
Objective benchmarks (ROM degrees, pain‑free status, gait quality, strength thresholds) that dictate safe transition from one phase to the next.