Evidence based rehabilitation programme

GOALS OF PHASE 1 (0 TO 2 WEEKS)

Protect the graft

  • Reduce swelling and pain
  • regain the patella’s movement
  • regain full extension and progressively enhance flexion
  • reduce muscle inhibition that causes arthritis, restore quad control, and regain full active extension

WEIGHT BEARING

WALKING

  • At first, the knee brace was locked and the walking aid were used (as the doctor suggested). After that, the person could start walking without assistance devices as long as there was no more inflammation, pain, or an incorrect gait. The allograft and hamstring autograft could keep using assistance devices for 6 weeks unless the doctor told them to stop.
  • You can unlock the knee brace once you can do a straight leg raise without any problems.
  • You can stop using the brace after six weeks, as long as you have good quad control.(Adams et al., 2012)

INTERVENITON

MANAGEMENT OF SWELLING:

  • Ice, compression, and raising your knee according to the advise of your doctor
  • perform massage in upward direction to reduce swelling
  • active and passive heel raise

Range of motion and mobility

  • Mobilise the surgical side’s Patella superior, inferior, medial, and lateral. Effective post-surgery exercises include assisted knee flexion and extension while sitting, heel slides with a towel, and low-intensity, long-duration stretches like prone hang and heel prop.
  • Standing gastroc and soleus stretching
  • Lying-down hamstring stretching

Consider providing patients home units following surgery. Avoid straight leg raises if your knee extension is lacking.
Hip abduction • 90- and 60-degree isometrics for angled knee extension

WHEN TO PROGRESS

  • Don’t progress to the next phase until patient have achieved complete knee extension
  • Maintain superior patellar mobilization with active quadriceps muscles contraction while keeping his knee in proper active extension

PHASE 2 (3 TO 5 WEEK)

In this phase of rehabilitation our main focus will be on normalizing the gait pattern while keeping his graft and surgical site protected and actively maintaining his knee extension. In short, with goals of phase 1 we have to focus on gait training.

Additional interventions with interventions of phase 1

INTERVENITON

Range of motion and mobility

Stationary bicycle Gentle muscular stretching, including prone quad, standing quad, and kneeling hip flexor stretches.
becoming stronger
Help the patient strengthen their hips and thighs with these exercises. Standing hamstring curls
Step-ups and marching step-ups, partial squats, ball, wall and mini squats (0–60 degrees), and bridge, unilateral bridge, sidelying hip external rotation clamshell, physioball bridges, roll-in bridge, alternating bridge and hip hike strengthened the lower back and pelvis.(Di Stasi et al., 2013)

For Balance and proprioception

  • Standing on one leg with a slightly bent knee, static to dynamic, and level to unsteady surface • Lateral step-overs • Joint position re-training (Di Stasi et al., 2013)

WHEN TO PROGRESS TO NEXT PHASE:

  • Don’t progress to the next phase of rehabilitation until patient’s affected knee has no signs of swelling, both knees (affected and non-affected) has same degree of knee extension and flexion.

PHASE 3 (6- 8 WEEKS)

REHABILITATION GOALS

Keep protecting the graft site.

  • Keep full range of motion
  • Safely increase strength
  • Practice correct movement patterns
  • Stay away from activities that cause pain at the graft donor site

ADDITONAL INTERVENTIONS WITH PHASE 1 & 2

If your ROM is limited, consider rotating tibial mobilisations.
Do elliptical, stair climber, flutter kick swimming, and water jogging for 8 weeks.
Getting stronger
Gym equipment includes the leg press, seated hamstring curl, hip abductor and adductor, hip extension, roman chair, and sitting calf machine.

  • At 12 weeks, hamstring autografts may strengthen with resistance. Increase strength and endurance by working out harder and longer. ** The following exercises should emphasise good proximal stability and precise control.
    Lateral lunges Romanian deadlift
  • One-legged progression: half weight-bearing single leg press, slide board lunges to the back and side, step-ups and march, lateral step-ups, step-downs, single-leg squats, and wall slides. (Mandelbaum et al., 2005)

WHEN TO PROGRESS TO NEXT PHASE:

  • No discomfort, swelling, or effusion after exercise
  • Normal gait
  • Range of motion equal to the other side
  • Joint position sense that is symmetrical (within 5 degrees)

PHASE 4 (9-12 weeks)

GOALS OF REHABILITATION

To prevent pain and swelling after exercise, you should maintain your full range of motion (ROM), safely increase your strength, encourage the correct movement patterns, stay away from activities that cause pain at the graft donor site, and encourage the right movement patterns.

ADDITONAL INTERVENTIONS WITH PHASE 1 & 2

In the sagittal plane, start submaximal sport-specific training.
Take a start from partial weight bearing to full weight bearing plyometric exercises.

WHEN TO PROGRESS TO NEXT PHASE:

There were no instances of instability; quadriceps strength was maintained; ten repetitions of single-leg squats were performed with appropriate technique for at least sixty degrees of knee flexion.

  • Perform a vertical drop from a solid control position.
  • The KOOS-sports questionnaire received more than seventy percent. (Wright et al., 2015)