Normalise gait – progression to full weight bearing in brace (as below)
Use of crutches for mobility – WBAT
Restricted mobilisation:
A limited motion knee brace is used. The brace is locked into full extension from 0-10 days
Then increased to 30 degrees at 10 days
Then 60 degrees at 3 weeks
And 90 degrees at 5 weeks
The brace is removed at 6 weeks
Rehabilitation:
Ice
Lying: Regain VMO activation and control at allowable ranges. E.g. supine straight leg raise with foot out turned, lift, hold and lower. Repeat 3×6 times
Ankle pumps (plantarflexion and dorsiflexion and progress to use of thera-band for resistance)
Manual therapy: Release of lateral structures (ITB and VL)
Tape if necessary for pain
Gait re-education
Swelling control
Standing: Calf raises: Start with double leg eg: 4×15 then to single leg calf raises
Side-lying leg lifts: Lift and lower leg (continuous manner, slow and controlled) 4×20
Phase 2: (6 – 12 weeks) functional restoration
Goals:
Regain control/functional stability
Establish (proximal) gluteal and pelvic stability
Pain free gait
Rehabilitation:
Standing: Proprioceptive exercises: First on firm/stable surface then to soft/unstable surface. Single leg balancing.
Use of biofeedback for adequate VMO contraction during step-ups, mini-squats and mini-lunges
Gluteus medius strengthening in standing. E.g. standing next to a wall/bench. Bend uninvolved leg up and push (knee) out/horizontally into the wall (hold a folded towel against wall with knee). Stabilising an upright and symmetrical stance by activating the involved leg’s Glute med – by resisting the outwards push (ensure pelvic alignment with hands on hips). Hold for 30sec and repeat 4 times.
Lying: Gluteal and Hamstring strengthening: Double leg to single leg bridging, focusing on pelvic control
Manual therapy: Lateral structure release as needed
Taping if necessary
Phase 3: (3 – 6 months)
Goals:
Full range of motion
No effusion/swelling
Improve quadriceps, hip and core strength
Improve balance and proprioception
Rehabilitation:
Gentle quadriceps, gluteal, hamstring, gastrocnemius and soleus stretching
Single leg press (start with a low weight, ensuring proper limb alignment)
Stationary bike cycling – progressive resistance as tolerated
Gentle swimming (no breaststroke kicking)
Progress to dynamic proprioceptive exercises: E.g. deceleration focus
Progression to multi-planar agility drills with a progressive increase in velocity and amplitude
Increase eccentric quadriceps work – use of decline board