STAGE 1: Approx 0-4 weeks
Aims/restrictions
Achieve full extension to 90 degrees flexion
Minimal morning joint effusion
Closed kinetic chain quadriceps exercises only
Full weight bearing (with aids if required)
Treatment
Adequate analgesia
Swelling management
Gait re-education
Stretches of tight structures
Strengthening of muscles stabilising the knee (open chain allowed for hamstrings)
Manual therapy – soft tissue and joint
Hydrotherapy / electrotherapy: if available and thought to be appropriate
STAGE 2: Approx 4-12 weeks
Aims / restrictions
Avoid jogging / impact exercise
Optimise normal movement
Improve strength and balance / proprioception
Treatment
As stage 1 plus:
Educate patient to avoid activities that provoke significant shear forces or impact
Strengthening – increasing resistance work with weights / therabands
Core stability work
Balance – double to single leg stance, eyes open and closed
STAGE 3: Approx 12 weeks onwards
Aims
Normal movement and muscle strength
Hopping / cutting with good control
Return to sport from 6 months
Treatment
As stage 2 plus:
Increased dynamic work : hopping, cutting etc
Balance/proprioception: Wobble boards, trampette, gym ball etc
Sports/occupation specific drills once balance/proprioception allows
