Initial Precautions

• Range of Motion: Limitation of 0–90° for the first 6 weeks. Start progressing range of motion 10 to 15 degrees per week, with a goal of full range of motion by 10 weeks.
• Weight-Bearing Status: Toe-touch weight-bearing until the 6-week appointment. Progress weight-bearing by approximately 25% per week after that.

Phase I: Maximum Protection (Weeks 0 to 6)

Weeks 0 to 2:

• Ice and modalities to reduce pain and inflammation.
• Range of motion: 0–90°.
• Toe-touch weight-bearing.
• Elevate the leg above the heart for the first 3 to 5 days.
• Initiate patella mobility drills.
• Gait training with crutches (NWB).

Weeks 2 to 6:

• Continue modalities to control inflammation.
• Maintain program from Week 0–2.
• Begin gentle knee ROM exercises, goal of >90° flexion by Week 4.
• Progress multi-plane hip strengthening on uninvolved side.
• Emphasize neuromuscular control and proprioception drills.

Phase II: Progressive Stretching and Early Strengthening (Weeks 6 to 12)

• Continue with modalities as needed.
• Continue exercises from Phase I.
• Emphasis on achieving and maintaining full ROM.
• Stationary bike with resistance.
• Begin multi-plane quadriceps strengthening.
• Progress weight-bearing as tolerated. Gradual transition to full weight-bearing.
• Initiate light resistance training for the hip and knee.

Phase III: Strengthening and Proprioception (Weeks 12 to 16)

• Continue progressing resistance exercises.
• Begin functional exercises, including step-ups and lunges.
• Increase intensity of quadriceps and hamstring strengthening.
• Emphasis on proprioception and balance exercises.
• Start light cardiovascular exercises such as cycling and low-impact aerobics.

Phase IV: Return to Activity (Weeks 16+)

• Gradual return to functional activities with no impact.
• Progress strength and endurance.
• Include dynamic stabilization and core strengthening.
• Consider resuming activities of daily living.