Intended for licensed physical therapists coordinating care with Dr. Vasileff. Defer to the operative note and the surgeon’s office for patient-specific direction.

Knee · Fracture

Patella Fracture (Non-Operative)

Non-operative protocol · Dr. Chris Vasileff, MD

For the treating physical therapist. This protocol is a guideline; progression is criteria-based and individualized. Defer to the operative note and the surgeon’s office for patient-specific direction.

CHRISTOPHER C. VASILEFF, MD

Orthopaedic Sports Surgery Specialist

www.carolinaorthopaedic.com

Phone: 704-865-0077 ◊ Fax: 704-867-6401

NON-OPERATIVE PROTOCOL FOR PATELLA FRACTURE

PHYSICAL THERAPY / REHAB PHASES

Phase 1: 0-4 Weeks

• Range of motion (ROM):

o hinged knee brace locked at 0 degrees

o intermittent active and active assisted flexion with passive extension for 5-10 minutes QID o patellar mobilization activity

o stay within 0-45 degrees ROM

o Strength: isometric hamstrings utilizing an endurance program of 10-40 repetitions per set with 5 sets per day

• Weight bearing:

o 100% with brace locked in full extension

o Modalities: EMG biofeedback to hamstrings (not quadriceps) prn

o EMS to hamstrings(not quadriceps) prn

o cryotherapy

• Sports: none.

Phase 2: 4-6 Weeks

• Range of motion (ROM):

o advance ROM as tolerated; brace locked in full extension when ambulating only! o Strength: Initiate quadriceps strengthening and SLR

• Weightbearing:

o 100% with brace locked in full extension Modalities: prn-as above

• Sports: none.

Phase 3: 6-8 Weeks

• Range of motion (ROM) and brace use:

o increase as tolerated

o DISCONTINUE BRACE IF YOU CAN WALK WITHOUT A LIMP AND IF YOU CAN MAINTAIN A STRAIGHT LEG RAISE WITHOUT YOUR LEG WOBBLING! o If the above conditions are not met, keep the brace on and walk with the brace unlocked!

o Strength: progress with exercises and hamstring and quadriceps strengthening • Weightbearing: full +/- brace; recommend using the brace (unlocked) if icy conditions outside or if the environment is dangerous / crowded public areas

• Sports: none

Phase 4: 8-12 Weeks (and beyond, if applicable)

• Range of motion (ROM) and brace use:

o If not weaned from brace yet, continue exercises and strengthening to do so at this time of ROM and strengthening as tolerated!

• Modalities: prn

• Sports: progress through graduated running program such as “functional rehabilitation program” o Resume main sports if patient has obtained near full ROM and has obtained at least 80% of quad and hamstring strength as compared to the other extremity.

• Usually back to full sports by 3-4 months. Progress through work conditioning, if applicable.

Questions about a protocol? Contact Dr. Vasileff’s office at (704) 865-0077.