Quad / Patellar Tendon Repair Rehabilitation Protocol

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.