This protocol is only a guideline and may be modified depending on the pre-operative and intra-operative findings. A physiotherapist who is experienced in knee rehabilitation should be consulted throughout the programme to supervise and where necessary individually modify your programme.

Aims of Rehabilitation:

To restore Range of Motion and Strength to the knee. The final goal is to minimize knee pain and improve your knee function to improve your quality of life.

0-2 weeks:

  • Intermittent cryotherapy to minimize joint swelling, Cryotherapy after exercises.
  • Circumferential compression dressing.
  • Elevate the affected limb to minimize swelling.
  • Ankle exercises for DVT prophylaxis.
  • Deep breathing exercises for basal atelectasis

Range of Motion / Strengthening Exercises:

  • Quadriceps sets, Gluteal sets.
  • Straight leg raises, supine.
  • Knee extensions supine over a roll.
  • Knee extensions from seated
  • Passive knee straightening with a heel roll supine.
  • Heel slides, seated and supine.

Functional Exercises:

  • Transfer lying to standing, and seated to standing.
  • Gait training with crutches, weight bearing as tolerated.
  • Into and out of a car.
  • Weight bear as tolerated.2

3-6 weeks:

  • Cryotherapy after exercises, heat packs may be used on the knee and thigh prior to exercises.
  • Gentle wound massage with Bio-oil or vitamin E cream (can be started at 4 weeks)
  • Circumferential compression dressing
  • Ankle exercises for DVT prophylaxis.
  • Patellar mobilization exercises.
  • Range of Motion / Strengthening Exercises
  • Isometric quads, hamstrings, gluteals, adductors.
  • Active and assisted range of motion exercises.
  • Supported standing heel raises, calf stretches, mini squats, hamstring curls.

Functional Activities:

  • Exercise bike (can be started once 90 degrees of flexion is achieved)
  • Gait – normalize gait, progress to a single point stick.
  • Increase endurance with longer walks and stairs.
  • Patients should be walking without aids by 6 weeks

7-12 weeks:

  • Patellar mobilization exercises.
  • Quads and hamstrings deep tissue massage.

Core strengthening exercises.

  • Squats and single leg stance mini-squats.
  • Resistance exercises for quadriceps, hamstrings, gluteals and adductors.
  • Active and assisted ROM exercises.

Functional Exercises:

  • Start driving using the affected leg.
  • Gait supervision without walking aids.
  • Lateral stepping.
  • Heel-toe walking.

13+ weeks:

Once the patient has achieved full extension and flexion >110°, normalized and unaided gait, and good muscle balance – institute an ongoing programme of regular exercise tailored to the patient.

This may include:

  • Regular walking
  • Exercise bike
  • Gentle gym workouts
  • Return to sport (golf, doubles tennis, lawn bowls, etc)

Encourage the patient to continue their exercise program indefinitely, to optimize the outcome from their surgery