Quadriceps Tendon Repair

Physical Therapy Protocol

Phase I – Protective Phase (Weeks 0–3)

Goals:

• Protect surgical repair
• Minimize pain and inflammation
• Prevent stiffness and quadriceps atrophy
• Begin gentle patellar and soft tissue mobility

Precautions / Restrictions:

• Weight Bearing: WBAT with brace locked in full extension (0-0°)
• Brace: Locked in full extension (0–0°) at all times
• ROM: No active flexion; passive extension only

Therapeutic Exercises:

• Patellar/tendon mobilization
• Extension mobilization
• Ankle pumps
• Quadriceps sets
• Hamstring sets
• Seated hamstring stretch with towel

Cardiovascular:

• Bike or rower (well leg only)

Phase II – Controlled Motion Phase (Weeks 4–6)

Goals:

• Restore gradual ROM (active flexion to 60°)
• Maintain quadriceps and hamstring activation
• Begin neuromuscular control in safe positions

Precautions / Restrictions:

• Weight Bearing: WBAT with brace locked in full extension (0–0°)
• Brace Settings: Continue locked at 0–0°
• ROM: Week 4: Active flexion 0–60°; advance flexion by 10° per week

Therapeutic Exercises:

• Seated flexion and wall slides (0–60°)
• Continue quad/hamstring sets
• Continue ankle pumps
• Sit-and-reach hamstring stretch
• Core and hip strengthening (without abduction/adduction)

Cardiovascular:

• Continue well-leg biking or rowing

Phase III – Progressive Strengthening Phase (Weeks 7–12)

Goals:

• Normalize gait and weight bearing
• Improve lower limb strength and control
• Restore ROM to near full range

Precautions / Restrictions:

• Brace Settings: Week 7: Unlock to 0–60°; advance 10° per week (e.g., 0–70°, 0–80°, etc.)
• ROM Goal: Full flexion by end of phase

Therapeutic Exercises:

• Continue wall and seated flexion/extension (matching ROM limits)
• Initiate toe and heel raises
• Begin balance series (within ROM limits)
• Start weight-bearing strengthening:
• Double leg bridges
• Double knee bends
• Static lunges
• Beginning cord resistance

Cardiovascular:

• Stationary bike (both legs – start no resistance, then progress)
• Treadmill walking (7% incline)
• Aquajogging and swimming (if incisions healed)

Phase IV – Advanced Strengthening & Agility (Weeks 12–20)

Goals:

• Develop dynamic strength, balance, and endurance
• Initiate sport-specific preparation
• Normalize single-leg control

Therapeutic Exercises:

• Leg press
• Balance squats
• Single leg deadlifts
• Advanced cord drills
• Agility progression:
• Running progression
• Single-plane agility
• Multi-directional drills

Cardiovascular:

• Elliptical trainer
• Rowing
• Stair stepper

Phase V – Return to Sport & High-Level Function (Weeks 20–24+)

Goals:

• Return to full, pain-free activity and sport
• Reintroduce high-level and impact-based movements

Therapeutic Exercises:

• Functional sports testing
• Plyometric progressions (as appropriate)
• Continued agility work

High-Level Activities:

• Golf, outdoor biking, hiking, snowshoeing
• Return to higher-demand sports (basketball, tennis, soccer, skiing) with clearance