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 · Tendon

Quadriceps / Patellar Tendon Repair

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 0-6):

0-2 weeks:

  • Brace locked in full extension for 6 weeks during ambulation
  • Partial weight bearing for 2 weeks
  • Ice and modalities to reduce pain and inflammation
  • Aggressive patella mobility drills
  • Range of motion – 0° to 30° knee flexion
  • Begin quad sets (no straight leg raise until week 3)
  • * No SAQ/LAQ until Phase II
  • * No bike until Phase II

Weeks 2-4:

  • Weight bearing as tolerated; progressing off of crutches
  • Continue with inflammation control
  • Continue with aggressive patella mobility
  • Range of motion – 0° to 60°
  • Continue with quad sets/AA SLR in brace, use NMES as needed

Weeks 4-6:

  • Full weight bearing
  • Continue with ice and aggressive patella mobility
  • Range of motion – 0° to 90° (by week 6)
  • Continue with quad sets/AA SLR in brace

Phase II – Progressive Range of Motion & Early Strengthening (Weeks 6-12):

Weeks 6-8:

  • Full weight bearing
  • 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 ≥115°
  • Initiate pool program

Weeks 8-10:

  • Wean out of brace
  • Continue with patella 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 forward and backward
  • Begin elliptical trainer

Weeks 10-12:

  • Full ROM
  • Terminal quadriceps stretching
  • Advance unilateral open and closed kinetic chain strengthening
  • Blood flow restriction therapy to build muscle mass and assist with quad activation

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

Weeks 12-16:

  • 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
  • Core Program
  • Front plank – full, may advance to alternating leg lift
  • Bridge – marching or single leg
  • Side plank – full
  • Dead bug progression
  • Quadruped alternating arm-leg

Phase IV – Advanced Strengthening & Functional Drills (Weeks 16-20):

Weeks 16-20:

  • May begin leg extensions; 30° to 0° progressing to full ROM as patellofemoral arthrokinematics normalize
  • Begin pool running program advancing to land as tolerated
  • *No loaded deep knee flexion for 4-6 months
  • *Begin LAQ at 4 months at earliest

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

Weeks 20-24:

  • 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 (Sport Cord Test @ 6mo if appropriate)

RETURN TO ACTIVITIES

Swimming free-style: 8-10 weeks when functional criteria are met

Shallow water pool running: 8-10 weeks when functional criteria are met

Outdoor Biking: 3 months when functional criteria are met

Running: 4-5 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.