The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an arthroscopic assisted/mini-open rotator cuff repair. It is by no means intended to be a substitute for one’s clinical decision-making regarding the progression of a patient’s postoperative course based on their physical exam/findings, individual progress, and/or the presence of postoperative complications. If a clinician requires assistance in the progression of a postoperative patient, they should consult with Dr. Roe.
Progression to the next phase based on clinical criteria and/or time frames as appropriate.
Phase I – Acute Ambulation:
Goals:
- Full knee extension and quadriceps activation.
- Patellar and fat pad mobility.
- Restore balance and gait/walking.
Criteria for Phase Progression:
- Pain < 5/10 at worst and IKDC score > 30.
- 0 knee extension or symmetry.
- 110 of knee flexion.
- Adequate single-leg balance (firm ground).
- Good quad activation and endurance with straight leg raise test.
Phase II – Functional Symmetry:
Goals:
- Progress Strength and symmetry with functional movements.
- Normalize balance and proprioception.
Criteria for Phase Progression:
- Pain < 4/10 at worst and IKDC score > 40.
- Near normal knee extension, at least to 0.
- Adequate knee flexion per procedure appendix.
- Symmetrical double leg squat.
- Adequate single-leg balance (unstable platform).
Phase III – Strength:
Goals:
- Emphasize single-leg squat mechanics and balance.
- Promote strength on the involved lower extremity.
- Improve strength of compound movements.
Criteria for Phase Progression:
- Pain < 3 and IKDC > 60.
- Maintain knee extension to at least 0.
- Increase quad/hamstring strength - isometric strength > 60% symmetry.
- Good single leg balance and control by single-leg squat < 4 cm diff.
- Restore single leg muscle endurance by Vail single-leg squat test > one minute.
Jogging Program:
1. Full knee extension and no pain > 3/10
2. > 1 min of single-leg squats
Walk Time | Jog Time | Total Time | ||
Phase 1 | (3 days) | 1 min | 2 min | 12 min |
Phase 2 | (3 days) | 1 min | 4 min | 15 min |
Phase 3 | (3 days) | 1 min | 6 min | 21 min |
Phase 4 | (3 days) | 1 min | 8 min | 24 min |
Phase 5 | (3 days) | 1 min | 10 min | 20+ min |
Phase 6 | progress as tolerated without walking breaks |
Phase IV – Power and Agility:
Goals:
- Continue gaining strength.
- Introduce plyometric and agility movements.
Criteria for Phase Progression:
- Full ROM passive and active.
- Symmetric knee strength by HS/Quad ratio > 55% and 85% symmetry.
- Neuromuscular control with jumping by Landing Error Scoring System (LESS).
- Demonstrate single-leg power by Single Leg Hop for Distance > 80% symmetry.
Phase V – Return to Sport:
Goals:
- Introduce sport-specific stimuli and unpredictable movements.
- Facilitate graded return to full competition.
Criteria for Phase Progression:
- Restore confidence and reduce fear of movement by ACL-RSI.
- Full knee ROM passive and active.
- Symmetric knee strength by HS/Quad ratio > 55% and 90% symmetry.
- Neuromuscular control with jumping by Landing Error Scoring System (LESS).
- Symmetry on Hot Tests by Single Leg Hop for Distance > 80% symmetry.
- Symmetrical agility by figure of 8 Test, 5-10-5 Test > 95% symmetry.
- Complete injury prevention program with Sports Metrics.
Meniscus/Cartilage Protocol
Range of Motion, Weightbearing and Functional Restrictions
Passive ROM Limitations for Meniscus and Chondral Procedures | |
MENSCAL/CHONDRAL PROCEDURE | PROM LIMITS (EXTENSION - FLEXION)* TIMEFRAME GOAL(S) |
Body Repair (Small) | Weeks 0-2 Allow 0-90 After Week 2 Allow Full ROM |
Body Repair (Large) | Weeks 0-2 Allow 0-90 After Week 2 Allow Full ROM |
Root Repair | Weeks 0-2 Allow 0-60 Weeks 2-4 Allow 0-120 After Week 6 Allow Full ROM |
Meniscus Transplant | Weeks 0-2 Allow 0-60 Weeks 2-4 Allow 0-120 After Week 6 Allow Full ROM |
Trochlear MicroFx | Allow Full ROM Immediately |
Chondral MicroFx/Carticel/OATS | Weeks 0-2 Allow 0-60 Weeks 2-4 Allow 0-120 After Week 6 Allow Full ROM |
*All Motion and Timelines are for Non-Weight Bearing Activities |
Weight Bearing and ROM Limitations for Meniscus and Chondral Procedures | |
MENSCAL/CHONDRAL PROCEDURE | PROM LIMITS (EXTENSION - FLEXION)* TIMEFRAME GOAL(S) |
Body Repair (Small) | Allow Immediate FWB* in Extension Allow Loaded Flexion > 90 at 4 Weeks |
Body Repair (Large) | Allow Immediate FWB* in Extension Allow Loaded Flexion > 90 at 6 Weeks |
Root Repair | Weeks 0-4 TTWB Allow Immediate FWB in Extension at 4 Weeks Allow Loaded Flexion > 90 at 8 Weeks |
Meniscus Transplant | Weeks 0-4 TTWB Allow Immediate FWB in Extension at 6 Weeks Allow Loaded Flexion > 90 at 10 Weeks |
Trochlear MicroFx | Allow Immediate FWB*in Extension Allow Loaded Flexion > 90 at 4 Weeks |
Chondral MicroFx/Carticel/OATS |
Weeks 0-4 TTWB |
*FWB - Full Weight Bearing *TTWB - Toe-touch Weight Bearing |
Functional Progression of Meniscus and Chondral Procedures | |
MENSCAL/CHONDRAL PROCEDURE | MINIMAL TIMELINE FOR PROGRESSION |
FULL AMBULATION WITHOUT ASSISTIVE DEVICE | |
Body Repair (Small) | 2 Weeks |
Body Repair (Large) | 4 Weeks |
Root Repair | 6 Weeks |
Meniscus Transplant | 6 Weeks |
Trochlear MicroFx |
2 Weeks |
Chondral MicroFx / Carticel / OATS | 6 Weeks |
INITIATE JOGGING | |
Body Repair (Small) | 3 Months |
Body Repair (Large) | 4 Months |
Root Repair | 4 Months |
Meniscus Transplant |
4 Months |
Trochlear MicroFx | 3 Months |
Chondral MicroFx / Carticel / OATS | 5 Months |
INITIATE AGILITY | |
Body Repair (Small) | 4 Months |
Body Repair (Large) | 5 Months |
Root Repair |
5 Months |
Meniscus Transplant | 6 Months |
Trochlear MicroFx | 4 Months |
Condral MicroFx / Carticel / OATS | 6 Months |
FULL RETURN TO SPORT | |
Body Repair (Small) | 6 Months |
Body Repair (Large) |
7 Months |
Root Repair | 8 Months |
Meniscus Transplant |
9 Months |
Trochlear MicroFx | 6 Months |
Condral MicroFx / Carticel / OATS | 9 Months |