knee- patellofemoral- revision unilateral patellar tendon repair
This document outlines a structured, phase‑based rehabilitation program for patients after revision unilateral patellar tendon repair. It is divided into five chronological phases: (I) Immediate Post‑operative (Days 1‑7) focusing on pain control, full passive knee extension, early controlled motion, and protected weight‑bearing with a locked brace; (II) Maximum Protection (Weeks 2‑6) gradually increasing knee flexion, maintaining a locked brace, progressing weight‑bearing from toe‑touch to 50 % body weight, and introducing electrical stimulation, quad sets, and pool exercises; (III) Moderate Protection (Weeks 7‑16) unlocking the brace for ambulation, advancing ROM to 100‑110°, adding strength and functional drills such as straight‑leg raises, hip ab/adduction, cycling, and light leg press; (IV) Light Activity (Months 4‑6) emphasizing strength, endurance, eccentric work, and functional activities while allowing knee flexion beyond 115°; and (V) Return‑to‑Sport (Months 7‑9) which requires a satisfactory clinical exam, strength, proprioception (>80 % of the contralateral leg), and appropriate rehab progression before gradual re‑introduction of unrestricted sports, agility, and sport‑specific training. Throughout, the protocol stresses brace usage, weight‑bearing limits, ice/compression, and physician‑guided progression.
Topics
Immediate Post‑operative Phase (Days 1‑7): Pain Management and Early Motion
Defines goals (full passive extension, pain/swelling control, patellar mobility), brace protocol (drop‑locked at 0°), weight‑bearing limits (toe‑touch, ≤25 % BW), ROM limits (0‑20° then 0‑30°), and foundational exercises (ankle pumps, quad sets, patellar mobilization) with ice/elevation.
Maximum Protection Phase (Weeks 2‑6): Controlled Flexion and Strength Initiation
Outlines progressive ROM targets (0‑30° to 0‑75°), brace status (locked until 4‑6 weeks), weight‑bearing progression (toe‑touch to 50 % BW with crutches), and exercises (electrical muscle stimulation, quad sets, ankle pumps, pool exercises) while continuing ice/compression.
Moderate Protection Phase (Weeks 7‑16): Functional Strength and Ambulation
Describes unlocking brace for ambulation, discontinuing brace during sleep, ROM advancement to 0‑110°, and a graduated strengthening program (straight‑leg raises, hip ab/adduction, cycling, pool program, light leg press, lateral step‑ups) with a clear “no sports” directive.
Light Activity Phase (Months 4‑6): Endurance, Tensile Strength, and Functional Integration
Focuses on enhancing muscular endurance, eccentric training, functional activities, and allowing knee flexion beyond 115°, while maintaining the established strengthening regimen.
Return‑to‑Sport Phase (Months 7‑9): Criteria‑Based Re‑entry to Full Activity
Specifies objective criteria (clinical exam, strength, proprioception ≥80 % of opposite leg, appropriate rehab progression) and goals (gradual unrestricted sport, continued strength, agility, and sport‑specific drills) with physician oversight.
Protocol Compliance and Physician Oversight
Emphasizes the importance of adhering to brace, weight‑bearing, and progression guidelines, and highlights that all activity initiations are contingent upon physician decision to ensure safe healing.