Phase I: Protection and Early Recovery (0–6 Weeks)

Immobilisation:

• Knee brace in full extension for ambulation

• Brace worn at all times, including during sleep

• Weight bearing as tolerated with crutches initially as required

Precautions:

• Avoid active knee extension against resistance

• Avoid passive knee flexion beyond prescribed limits

• Avoid straight leg raise if extensor lag present

• Protect repair at all times

Therapy:

• Passive range of motion 0–45° initially, progressing gradually to 90° by 6 weeks

• Emphasis on full knee extension

• Quadriceps activation (isometric quads sets)

• Straight leg raises in brace if no lag

• Patellar mobilisation

• Swelling management (ice, compression, elevation)

Criteria to Progress:

• Healing wound

• Ability to perform straight leg raise without lag

• Controlled pain and swelling

• Knee flexion progressing as per protocol

Phase II: Progressive Motion and Early Strengthening (6–12 Weeks)

Immobilisation:

• Discontinue knee brace as quadriceps control improves

Precautions:

• Avoid resisted knee extension early in this phase

• Avoid sudden or excessive knee flexion

• Avoid high-load activities

Therapy:

• Progress to full range of motion

• Begin gentle active knee extension

• Closed chain strengthening (sit-to-stand, mini squats within safe range)

• Gait retraining and normalisation

• Balance and proprioceptive training

• Stationary cycling

Criteria to Progress:

• Full or near full range of motion

• Good quadriceps control

• Normal gait pattern

• Minimal swelling

Phase III: Advanced Strengthening (12–16 Weeks)

Precautions:

• Avoid high-impact or explosive activities

Therapy:

• Progressive strengthening including open and closed chain exercises

• Single-leg strengthening and control

• Step-downs, lunges, and leg press progression

• Advanced balance and proprioception

• Cardiovascular conditioning

Criteria to Progress:

• Good strength and control

• No significant pain or swelling

• Functional independence

Phase IV: Return to Function and Activity (4–6 Months)

Precautions:

• Gradual return to higher-level activities

• Avoid premature return to high-impact sport

Therapy:

• Progressive strengthening and endurance training

• Running progression when appropriate

• Plyometrics and sport-specific training as indicated

• Criteria for Return to Activity

• Full range of motion

• Strength at least 90% of contralateral limb

• Good dynamic control

• No pain or swelling

General Recommendations

Work:

• Desk-based work may resume after 2–4 weeks.

• Manual labour is typically deferred until 2–3 months depending on job demands and recovery progression.

Driving:

• It is important that you are medically fit to return to driving and you feel safe to control the vehicle and take evasive action if needed.

• In general, for left knee surgeries in vehicles with automatic transmission, return to driving may be sooner.

Sports and Leisure:

• Low-impact activities may resume from 3–4 months.

• Running and higher-impact activities may commence around 4–6 months depending on recovery.

Thromboprophylaxis

For this procedure, postoperative thromboprophylaxis may be considered, particularly in the setting of reduced mobility and brace immobilisation. The need for pharmacological thromboprophylaxis will be determined by A/Prof Ernstbrunner and his medical team based on the individual patient’s risk factors and comorbidities.

Disclaimer: This protocol is intended as a general rehabilitation guide only. Rehabilitation progression should always be individualised and may be modified by A/Prof Ernstbrunner and the treating rehabilitation team based on the patient’s clinical progress, surgical findings, and individual circumstances.