Biologic Knee Restoration- Fem-Tib

Phil Davidson M.D.
Eric Heiden M.D.
Karen Heiden M.D.
2200 Park Ave, Bld. D, Ste. 100
Park City, Utah 84060
435.615.8822
435.615.8823 fax
Articular Cartilage Rehabilitation – Davidson
Femoral-Tibial Articulation/Surgery
0- 2 Weeks Rehabilitation:
• Touch weight-bearing with 2 crutches
2/52
o When standing, ie brushing teeth,
weight bearing for balance
• Brace typically used only for immediate
post op transit and comfort first few days
• Range of motion – free flexion as
tolerated aiming for full flexion by 6th
week
• Patellofemoral mobilizations
• Assisted knee swings 5 mins 3x/day for
first 6 weeks
• CPM- If and when available
• Post Op day 3 to 10
• Begin 0-60˚
• Increase 5-10˚ per day as
tolerated
• Use machine minimum 4 hours
per day
• Once attain maximum flexion for 2
days discontinue machine
• Static bike after 1 -2 weeks when
comfortable flexion achieved. 500
revolutions 3 x/day.
No or minimal load.
• Cold therapy to be used as tolerated
• Limited strength training is initiated
immediately:
SLR no lag, IRQs, static quads, hams &
gluteii Open chain quads no resistance
Initial post operative goals week 2
• Full passive knee extension
• Minimal pain & swelling
2-6 Weeks Rehabilitation:
• Gradual progression wt bearing from
PWB FWB
•
•
•
•
•
•
•
•
•
•
•
•
IRQs
Heel slides
Knee Flex/ Ext (Gym ball – heel on ball)
Knee flex/ Ext/ Abd/ Add with knee Ext
Hamstring/calf Stretch in standing
Core stability exs (Gym ball)
Hydrotherapy/swimming (no breast
stroke, flutter style kick only ) 2/52 after
surgery
Knee Flex/Ext in standing with theraband
to resist (0-30º)
Proprioception work
Rowing machine
Leg press – no resistance (10º - 70º)
from 4/52
Hydrotherapy/swimming – no breast
stroke until 8/52
Week 6 Goals:
• FWB,
• FROM
• Normal gait
• Good knee control
7-12 Weeks Rehabilitation:
• Should have FROM
• Gait re-education
• Step ups on 10cm step (40º)
• Mini stepper
• Gym ball:
o Bridging
o Knee Flex/Ext sitting on ball,
double/ single
o Sit to Stand
• Rowing machine increasing loading
• Static bike with resistance/ outdoor
cycling on level ground
• Treadmill slow walking fwds/bwds
• 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
thermaband to resist with knee Ext
Single leg mini squats on trampette
Step on/off trampette with operated leg
Full stepper/cross trainer
If adequate extension control – can
begin fast walk on treadmill, gradually
progress to slow jog under supervision.

•
•
•
•
•
•
3 Month Goals:
• Pain free FROM
• Satisfactory eccentric control to
perform 10cm step down with
neutral pelvis
• Able to complete 1 hour of light
exercise
3 - 4 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
4 Months onwards: Return to full sport phase
• Should have confidence in knee
• Can now run unsupervised if adequate
control
• Accelerate/decelerate ¾ speed
• Figure of 8 runs fwds/bwds
• Slalom fwds/bwds
• Gradually introduce cutting/sudden stop
• Run – sit – run
• ↑ distance
• Progress to sprints 10m – 20m – 50m
• Can begin sports specific training when
agreed with consultant/physiotherapist
• Quads strength should be equal to other
leg
• Hamstrings 75% of quads
Articular Cartilage Rehabilitation – Davidson
Patella - Femoral Articulation/Surgery
0 - 2 Weeks Rehabilitation
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Full weight bearing immediately (as
confort allows) , with 2 axillary cruthes
and brace
Brace locked at 0-200 for 2/52 when
mobilizing - after 2/52 brace is
gradually opened before discontinued
after 3/52
Brace may be removed for sleeping
CPM- If and when available
o Post Op day 3 to 10
o Begin 0-75˚
o Increase 5-10˚ per day as
tolerated
o Use machine minimum 4 hours
per day
o Once attain flexion
>125˚discontinue machine
Range of motion (out of brace) – free
flexion as tolerated aiming for full
flexion by 6/52
Stationary bike after 1/52 to 2/52 when
comfortable flexion achieved. 500
revolutions 3 times a day. No or
minimal load.
Circulation exercises
Heel slides
SLR
Static quads & gluteii
Hamstring/calf stretches (Long sitting)
Heel raises in standing
Patella mobilisations (not into pain or
end of range)
Early proprioceptive Exs (Single leg
standing)
3 - 6 Weeks Rehabilitation:
• Brace is discontinued. Continue with
week 2 Exs
• Hip Flex/Ext/Abd/Add in standing knee
Ext with theraband
• Progress proprioception Exs
(Trampette single leg stand)
•
•
•
Gym ball Flex / Ext (Heel on ball)
Rowing machine
Static bike (must have at least 100º
flex)
Week 6 Goals:
• Full Ext
• 120° Flex
7-12 Weeks Rehabilitation:
• Progress to full ROM
• Gait Re-education
• Functional closed chain 10cm step ups
40º
•
•
•
•
Progress proprioception: Trampette double leg /
single leg stand
 Wobble board
Treadmill slow walk
↑ Static bike/ordinary Bike
Knee Ext 0 - 30º in standing with
resistance of theraband
3 Month Goals:
• Normal Gait
• Full AROM
• Good knee control
• No load on patellofemoral joint
for 3/12
• Reduced swelling & pain
3 – 4 Months Rehabilitation:
• ↑ Functional training
• Treadmill fast walk
• Stepper/cross trainer
• ↑ Walking distance
• Patellofemoral rehabilitation
• Lateral step downs on 10cm (40º) step
Forward step downs on 10cm step
Progress to 15cm step
• Circuit training
• Progress to jogging
4 Month Goals:
• FROM
• No pain or swelling
• Strength within 80-90% of
contralateral extremity (Quads &
hams)
•
Satisfactory eccentric control to
perform 10cm step down with
neutral pelvis
4 Months onwards: Return to full sport phase
• Exercises as per 4/12 femorol/tibial
rehab.
• Progressing to sport specific training