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Rehabilitation: Femoro-tibial Joint Lesions

0 – 3 Weeks Rehabilitation:
• Touch weight-bearing for 6/52 after surgery
• Range of motion – free flexion as tolerated aiming for full flexion by 6/52
• Patellofemoral mobilisations
• Assisted knee swings 15 mins 3x/day for 6/52
• Stationary bike after 1 -2/52 when comfortable flexion achieved. 500 revolutions 3 times a day. No or minimal load.
• Cold therapy may be used as required
SLR no lag, Static quads, hamstrings & gluteii Open chain quads no resistance
• Hamstring/ Calf Stretch (long sitting)

3 – 6 Weeks Rehabilitation:
• Remain touch weight-bearing for 6/52
• Core stability in sitting
• IRQs Hip Flex/Ext/Abd/Add with knee Ext
• Knee Flex/Ext (Gym ball – heel on ball)

Week 6 Goals:
• Minimal pain and swelling
• FROM

7 – 8 Weeks Rehabilitation:
• Progress PWB-FWB
• Core stability exs with gymball
• Hamstring/calf stretches in standing
• Stationary bike: increase load as tolerated
• Gym ball:
-Bridging
-Knee Flex/Ext sitting on ball. Double/ single
-Sit to stand

Week 8 Goals:
• Mobilise unaided
• Satisfactory static proprioception

9 – 12 Weeks Rehabilitation:
• Continue with Week 6 Exs
• Knee Flex/Ext in standing with theraband to resist (0-30º)
• Proprioceptive work
• Rowing machine
• Leg press – low resistance (10º – 70º)
• Hydrotherapy/swimming

Week 12 Goals:
• FWB Normal gait
• FROM
• Good knee control

3 – 4 Months Rehabilitation:
• Gait re-education
• Step ups on 10cm (40º) to 15cm (60º) step
• Mini stepper
• Static bike with resistance/outdoor cycling
• Treadmill: slow walking forwards/backwards
• Increase proprioception
-Trampette single leg stands
-Single leg mini squat
-Wobble board
• Lateral step downs on 10cm (40º)step
Forward step downs on 10cm step
• Hip Abd/Add/Flex/Ext in standing + theraband

4 Months Goals:
• Pain free FROM
• Good control of 10cm forward step down
• Increased confidence in knee

4 – 5 Months Rehabilitation:
• Single leg mini squats on trampette
• Step on & off trampette with operated leg
• Full stepper/crosstrainer
• Lateral/forward step down 15cm to 20cm (80º)
• If adequate knee control – can begin fast walk on treadmill, gradually progressing to slow jog under supervision

5 Months Goals:
• Satisfactory knee control fast walking
• Perform 20cm step down & neutral pelvis
• Able to complete 1 hour of light exercise

5 – 6 Months Rehabilitation:
• Circuit training
• Gentle jog/shuttle runs
• Gentle change of direction
• Single leg hurdle/step over
• Accelerate/decelerate up to 50% speed
• Plyometrics: skipping, hopping, star jumps

6 Months onwards: Return to full sport phase
• Should have confidence in knee
• Can now run unsupervised if adequate control
• Accelerate/decelerate runs ¾ speed
• Figure of 8 runs fwds/bwds
• Slalom fwds/bwds
• Gradually introduce cutting/sudden stop
• Run – sit – run
• ↑ distance: sprints 10m – 20m – 50m
• Can begin sports specific training when agreed with consultant and physiotherapist

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