The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone a quadriceps or patellar tendon 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.
Phase I – Acute (0-6 Weeks):
Goals:
- Protect repair
- Restore ambulation
- Restore ADLs
Weight Bearing:
- 0-4 Weeks: Weight-bearing as tolerated (with brace locked in full extension).
- 4-6 Weeks: Crutch assisted WBAT with brace -5-60.
- 6+ Weeks: Full weight-bearing (brace unlocked).
Brace and Crutch Use:
- 0-2 Weeks: Locked in full extension.
- 2-4 Weeks: -5-30 degrees.
- 4-6 Weeks: -5-60 degrees.
- 6+ Weeks: Unlock brace to full if good quad control.
Strength and Conditioning:
- 0-6 Weeks: Quad sets, straight leg raises, weight shifts.
- 6+ Weeks: Single leg balance and continue above.
Criteria for Phase Progression:
- At least 6 weeks post-op.
- Pain less than 3/10 (worst).
- Within 2-degree normal knee extension and 75-degree knee flexion.
- Single leg balance > 20 sec (BESS).
- MD approval.
Phase II – Intermediate (6-16 Weeks):
Goals:
- Improve strength.
- Initiate jogging program (if applicable).
Range of Motion:
- 6-8 Weeks: Progress flexion to 120 degree.
- 8+ Weeks: Progress flexion to full.
Strengthening:
- 6-8 Weeks: Mini-squats, short arc quads, light leg press partial range, core exercises.
- 8-12 Weeks: Squat progression (bodyweight squats to weighted squats), long arc quad (no resistance).
- 12-16 Weeks: Single leg squats, barbell squats and deadlifts.
*No resisted open-chain quad strengthening for 12 weeks.
Conditioning:
- Biking to start at 110-degree flexion.
- Elliptical and rowing.
- Initiate jogging program at 16 weeks (if applicable).
Criteria for Phase Progression:
- At least 16 weeks post-op.
- Pain less than 3/10 (worst).
- Within 2-degree normal knee extension and 125-degree knee flexion.
- At least 1 minute of single-leg squats.
- MD or PT approval.
Phase III – Agility (16-24 Weeks):
Goals: Introduce dynamic and power movements.
Strengthening:
- 16+ Weeks: Gym strengthening (squats, deadlifts), core exercises (mountain climbers, planks, V-ups).
- 20+ Weeks: Olympic lifting (if applicable).
Conditioning:
- Biking, elliptical, jogging, swimming.
Plyometrics and Light Agility:
- 16-20 Weeks: Ladder drills, double leg hops, side shuffle.
- 6+ Weeks: Single leg box jumps and hopping, light agilities.
Criteria for Phase Progression:
- 20 weeks post-op.
- Pain less than 2/10 (worst).
- Quad and HS strength > 80% normal; > 50% H/Q ratio for females.
- At least 1 minute of single-leg squats (resisted).
- < 5 on landing error scoring system (LESS).
- MD or PT approval.
Phase IV – Return to Play (24+ Weeks):
Goals: Initiate sports-specific movements and return to play.
Strengthening:
- Progress gym routine (squats, deadlifts, Olympic lifting).
- Biodex quad and hamstring fatigue protocols and core exercises.
Conditioning:
- Jogging, biking and Swimming.
- Interval sprint workouts.
Plyometrics and Agility (2-3 days/week):
- Max effort box jumps (progress with rotation).
- Lateral and rotational agility.
- Single leg hops.
- Unpredictable cutting and contact drills.
Criteria for Return to Play:
- Pain less than 2/10 (worst).
- Quad and HS strength > 90% normal; > 60% HS/Quad ratio for females.
- At least 3 minutes of single-leg squats (resisted).
- 90% normal on all single-leg hop tests.
- 95% normal – Figure of 8, 5-10-5 pro-agility, and single-leg vertical jump.
- MD or PT approval.