Patellofemoral Cartilage Restoration

Physical Therapy Protocol

Phase I – Protection / Mobility (Post-Op Weeks 1–3)

Goals:

• Protect the surgical site
• Initiate gentle motion within protected range
• Activate quadriceps and VMO
• Begin safe mobility with assistive devices

Restrictions:

• PROM and AROM 0–20° (Week 1)
• PROM and AROM 0–60° (Weeks 2–3)
• Brace locked in extension unless performing exercises

Therapeutic Exercises:

• Isometric quadriceps sets
• Straight leg raises (SLR)
• Weight shifts in standing
• Patellar mobilizations
• Ankle pumps

Phase II – Strength (Post-Op Weeks 4–6)

Goals:

• Improve AROM
• Restore basic gait pattern
• Initiate controlled strengthening

Restrictions:

• Continue brace as needed, unlock as quad control improves
• Avoid open-chain resistance to the knee joint

Therapeutic Exercises:

• AROM to 0–125°
• Gait training with progressive weight bearing
• Stationary cycling for ROM (no resistance)
• Mini squats (pain-free)
• Single-leg balance drills
• Closed-chain quad/glute strengthening

Phase III – Dynamic Strength (Post-Op Weeks 7–12)

Goals:

• Achieve full AROM
• Normalize gait pattern
• Improve dynamic lower limb control

Milestones:

• Discontinue crutches and TROM brace
• Independent ambulation without gait deviations

Therapeutic Exercises:

• Step-ups and step-downs
• Lateral and diagonal movements
• Progressive resistance exercises for quads/glutes
• Core strengthening

Phase IV – Proprioceptive Phase (Post-Op Weeks 13–24)

Goals:

• Enhance neuromuscular control
• Improve balance and proprioception
• Increase functional strength

Therapeutic Activities:

• Single-leg balance on unstable surfaces
• Closed kinetic chain training
• Ergometers, elliptical, and stairmaster (as tolerated)
• Agility ladders and cone drills (if appropriate)

Phase V – Functional Return (Post-Op Month 6+)

Goals:

• Safely return to higher-level activities
• Prepare for sports or recreational return

Functional Progression:

• Begin running program (if cleared)
• Integrate plyometric and impact control drills
• Sport-specific exercises and interval training