Knee Dislocation, MCL and/or Acute

Days 1–14

Exercises

• Dressing – POD 1: Debulk dressing, TED Hose in place
  • POD 2: Change dressing, keep wound covered, continue TED Hose
  • POD 7–10: Sutures out, D/C TED Hose when effusion resolved
• Brace – Locked in extension x 4 weeks
• Crutches – Flat foot weight bearing (FFWB) in brace
• CPM – 0–45 degrees (2-hr increments for 8–10 hours/day)
• No AROM or AAROM by patient, No Stationary bike
• Patellar mobilization (teach patient)
• Calf pumping
• Passive extension to 0 degrees, No hyperextension
  • Calf (not heel) on bolster or prone hangs with tibia supported
• Electrical stimulation in full extension with quad sets and SLR
• Quad sets, Co-contractions quads / HS
• Straight leg raise (SLR) x 4 on mat in brace (parallel bars if poor quad control)
• Ice pack with knee in full extension after exercise

Goals

• PROM 0–45 degrees
• Good quad control

Weeks 2–4

Exercises

• Brace – Locked in extension x 4 weeks
• Crutches – Partial weight bearing (PWB) in brace
• Continue appropriate previous exercises
• AAROM by patient 0–60 degrees
• No AROM or Stationary bike x 6 weeks
• Scar massage when incision healed
• Weight shifts, Mini squats 0–30 degrees in brace (supported in parallel bars)
• Stretches – hip flexors, Hamstring with leg supported in brace

Goals

• AAROM 0–60 degrees
• No extensor lag

Weeks 4–6

Exercises

• Brace – Open to available range if pt has good quad control
  • Not to exceed 90 degrees
• Crutches – PWB, progress to Weight bearing as tolerated (WBAT)
• Continue appropriate previous exercises
• AAROM by patient 0–90 degrees
• No AROM or Stationary bike x 6 weeks
• Multi-angle Co-contractions quads / Hamstrings at 0, 20, 40, 60
• SLR x 3 on mat without brace (No ADD) – No resistance
  • No ABD if LCL involved
• Limited arc open chain quad extension 75–60 degrees
• Mini squats 0–45 degrees, supported in parallel bars
• Double leg heel raises

Goals

• AAROM 0–90 degrees

Weeks 6–8

Exercises

• D/C brace
• Crutches – WBAT, D/C when gait is normal
• Continue appropriate previous exercises
• PROM, AAROM, AROM 0–100 degrees
• Partial wall squats – No knee flexion past 45 degrees
• Forward, lateral, and retro step downs in parallel bars
  • No knee flexion past 45 degrees (small step)
• SLR x 3 (no ADD) with light weight below knee
• Single leg heel raises
• Leg press with resistance no more than ¼ body weight
  • No knee flexion past 45 degrees
• Stationary bike to assist with ROM
• Treadmill – Forward walking

Goals

• AROM 0–100 degrees
• Normal gait

Weeks 8–10

Exercises

• Continue appropriate previous exercises
• PROM, AAROM, AROM 0–115 degrees
• Leg press with resistance no more than ½ body weight
• Hamstring curls – Carpet drags or rolling stool (closed chain)
• Proprioceptive training – Single leg standing in parallel bars
  • Double leg BAPS for weight shift
• Stationary bike with minimal resistance
• Elliptical trainer
• Treadmill – Forwards and backwards walking
• Pool therapy – Walking / running (no kicking)

Goals

• AROM 0–115

Weeks 10–12

Exercises

• Continue appropriate previous exercises
• PROM, AAROM, AROM to regain full motion
• Hip machine x 4 bilaterally – Including ADD (and ABD)
• Leg Press 0–90 degrees with resistance as tolerated
• Proprioceptive training – Single leg BAPS, ball toss and body blade
• Stationary bike for progressive resistance and time
• Treadmill – Walking progression program

Goals

• Full AROM

Months 3–4

Exercises

• Sports Brace (per Ortho)
• Continue appropriate previous exercises with progressive resistance
• Leg press with single leg, no > 90 degrees
• Hamstring curl weight machine 0–90 degrees, light resistance < ¼ body weight
• Knee extension weight machine 0–90 degrees as tolerated
• Fitter
• Slide board
• Swimming

Goals

• Walk 2 miles at 15 min/mile pace

Months 4–6

Exercises

• Continue appropriate previous exercises
• Sit-up progression
• Treadmill – Continue speed walking, no running yet
• Stretches – Quads, ITB
• Transition to home / gym program

Goals

• Walk 3 miles at 15 min/mile pace

Months 6–12

Exercises

• Biodex depending on patient progress and surgeon request
• Continue appropriate previous exercises
• Agility drills / Plyometrics
• Treadmill – Running progression program

Goals

• Return to all activities
• Pass a return-to-sport / fitness test at 12 months post-op
• No contact or cutting sports until 12 months post-op

Home exercise sheet · knee phase 1

Perform exercises below frequently: 30 reps 3–5x a day

• Quad Isometrics
• Heel Slides
• Active Assisted Motion
• Ice Position 15 minutes 2–3 x per day

Abbreviations

AROM / AAROM / PROM: active / active-assisted / passive range of motion. ROM: range of motion. ER / IR: external / internal rotation. ABD / ADD: abduction / adduction. FLEX / EXT: flexion / extension. WBAT / PWB / TTWB / NWB: weight bearing as tolerated / partial / toe-touch / non-weight bearing. SLR: straight leg raise. HS: hamstrings. ITB: iliotibial band. UE / LE: upper / lower extremity. UBE: upper body ergometer (arm bike). BAPS: balance board. BFR: blood flow restriction training. PREs: progressive resistance exercises. D/C: discontinue. prn: as needed. POD: post-operative day. TENS: transcutaneous electrical nerve stimulation. ADLs: activities of daily living.

Source

Adapted from William Beaumont Army Medical Center, Physical Therapy Section, "Knee Dislocation MCL or Acute WB08", Revised August 2008, published by William Beaumont Army Medical Center (a work of the U.S. Government in the public domain). Original: Knee Dislocation MCL or Acute WB08.pdf. Army-specific wording in the original (APFT) was replaced with civilian equivalents.

This protocol is general guidance for the rehabilitation team and does not replace the specific plan, restrictions and follow-up we set together. Your own situation may differ: if anything here does not match what we talked about, what we talked about wins, so please ask me.

Current version and every other protocol: aaronweymd.com/post-op-protocols