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

Patella Fracture ORIF

Post-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.

Phase I – Maximum Protection (Weeks 0 to 6):

ROM AND EXERCISES WITH THERAPIST ONLY!

0 to 2 weeks:

  • Brace locked in full extension for 6 weeks
  • Partial weight bearing for 2 weeks
  • Ice and modalities to reduce pain and inflammation
  • Patellar mobility drills
  • Range of motion – 0° to 30°knee flexion
  • Straight Leg Raise in brace progressing to therapist assist

ROM AND EXERCISES WITH THERAPIST ONLY!

Weeks 2 to 4:

  • Weight bearing as tolerated; progressing off of crutches
  • Continue with inflammation control
  • Continue with patellar mobility
  • Range of motion – 0° to 30°
  • Continue with Straight Leg Raise in brace progressing to therapist assist

Weeks 4 to 6:

  • Full weight bearing
  • Continue with ice and aggressive patellar mobility
  • Range of motion – 0° to 60° (by week 6)
  • Continue with Straight Leg Raise in brace progressing to therapist assist

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

Weeks 6 to 8:

  • Full weight bearing
  • Slowly increase ROM to 0°-90°
  • Open brace to 45°- 60° of flexion week 6, 90° at week 7
  • Continue with swelling control and patellar mobility
  • Gradually progress to full range of motion
  • Begin multi-plane straight leg raising and closed kinetic chain strengthening program focusing on quality VMO function.
  • Initiate open kinetic chain progressing to closed kinetic chain multi-plane hip strengthening
  • Normalize gait pattern
  • Begin stationary bike
  • Initiate pool program

Weeks 8 to 10:

  • Wean out of brace
  • Increase ROM as tolerated
  • Continue with patellar mobility drills
  • Normalize gait pattern
  • Restore full ROM
  • Progress open and closed kinetic chain program from bilateral to unilateral
  • Increase intensity on stationary bike
  • Begin treadmill walking program

Weeks 10 to 12:

  • Full ROM
  • Aggressive terminal quadriceps stretching
  • Advance unilateral open and closed kinetic chain strengthening
  • Initiate proprioception drills
  • May introduce elliptical trainer

Phase III – Progressive Strengthening (Weeks 12 to 16):

Weeks 12 to 16:

  • Advance open and closed kinetic chain strengthening
  • Increase intensity on bike, treadmill, and elliptical trainer
  • Increase difficulty and intensity on proprioception drills
  • Begin gym strengthening: leg press, hamstring curls, ab/adduction; avoid lunges and knee extensions
  • Begin multi-directional functional cord program

Phase IV – Advanced Strengthening and Functional Drills (Weeks 16 to 20):

Weeks 16 to 20:

  • May begin leg extensions; 30° to 0° progressing to full ROM as patellofemoral arthrokinematics normalize
  • Begin pool running program advancing to land as tolerated

Phase V – Plyometric Drills and Return to Sport Phase (Weeks 20 to 24):

Weeks 20 to 24:

  • Advance gym strengthening
  • Progress running/sprinting program
  • Begin multi-directional field/court drills
  • Begin bilateral progressing to unilateral plyometric drills
  • Follow-up appointment with physician
  • Sports test for return to competition

RETURN TO ACTIVITIES

Running: 5-6 months when functional criteria are met

Golf: Short irons at 4 months, full swing with long irons at 5 months.

Delay 4-6 weeks if lead leg.

Pivoting/cutting sport: When functional criteria are met and cleared by surgeon, typically

7+ months at earliest

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