Manipulation under Anesthesia Rehab Protocol

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Phase 1 (0-2wks):

  • Goals: Control swelling, restore neuromuscular communication loops, prevent kinesiophobia; gait training
  • ROM: Aggressive ROM beginning post-operative day #0.
    • Focus on regaining terminal extension immediately, heel elevations, prone hangs.
    • Knee flexion ROM goal of 90 degrees.
  • Modalities: Compressive cyrotherapy, e-stimulation
  • Frequency: PT or home exercises 4-5days per week
  • Weightbearing: As tolerated
  • Brace: None
  • Exercises: Quadriceps isometrics, Heel slides, quad/hamstring sets. Patellar mobilization; SLR, planks, bridges, abs, step-ups and stationary bike as tolerated. Supine and prone PROM/capsular stretching with and without Tib-Fem distraction.

Phase 2 (2-4wks)

  • PT 3 days/wk
  • Weightbearing: Full
  • Brace: None
  • ROM: Full
  • Exercises: Progress phase 1 exercises. Advance rectus femoris/anterior hip capsule stretching. Cycling, elliptical, running as tolerated.

Phase 3 (4-12wks)

  • PT 2-3days/wk
  • Weightbearing: Full
  • Brace: None
  • ROM: Full
  • Exercises: Add sport-specific exercises as tolerated. Maintenance core, glutes, hip, and balance program.