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Knee Arthroscopy/Lateral Release Rehabilitation

This rehabilitation protocol is designed for patients who have undergone knee arthroscopy or arthroscopic lateral release. The intensity allowed and the time frame required for the rehabilitation process is dependent upon the surgical procedure and the clinical assessment. The protocol is divided into phases.

Each phase is adaptable based on the individual patient and special circumstances.

The overall goals of the surgical procedure and rehabilitation are to:

  • Control pain, swelling, and haemarthrosis
  • Regain normal knee range of motion
    • Regain a normal gait pattern and neuromuscular stability for ambulation
  • Regain normal lower extremity strength
    • Regain normal proprioception, balance, and coordination for daily activities
    • Achieve the level of function based on the orthopedic and patient goals


The physical therapy should be initiated within 3 to 5 days post-op. It is extremely important for the supervised rehabilitation to be supplemented by a home fitness program where the patient performs the given exercises at home or at a gym facility.


Important post-op signs to monitor:

  • Swelling of the knee or surrounding soft tissue
  • Abnormal pain response, hypersensitive
  • Abnormal gait pattern, with or without assistive device
  • Limited range of motion
  • Weakness in the lower extremity musculature (quadriceps, hamstring)
  • Insufficient lower extremity flexibility


Return to activity 

Returning to activity requires both time and clinical evaluation. To safely and most efficiently return to normal or high level functional activity, the patient requires adequate strength, flexibility, and endurance. Isokinetic testing and functional evaluation are both methods of evaluating a patient’s readiness to return to activity. Return to intense activities following a knee scope may increase the risk of an overuse injury or the possibility of compounding prior articular cartilage damages and symptoms such as pain, swelling, or instability should be closely monitored by the patient.  


Phase 1: Week 1-2  


Weekly Exercise Goals 

  • 1-2 ROM(Range of Movement) 0-90° 
  • Passive, 0-90° 
  • Patellar mobs 
  • Ankle pumps 
  • Gastroc/soleus stretch 
  • Prone hang if needed to reach goal 
  • Heel/Wall slides if needed to reach goal 

Strength

  • Quad sets with E-stim/biofeedback
  • Isometric hip adduction 
  • SLR in 4 planes 
  • Hip flexion 
  • Total gym (0-45°) 
  • Heel raises/Toe raises

Weight bearing PWB-WBAT

  • PWB to WBAT according to Dr. Lowe
  • Crutches post-op if needed

Balance Training

  • Weight shift (side/side, fwd/bkwd)
  • Single leg balance

Modalities

  • E-stim/biofeedback as needed
  • Ice 15-20 minutes

Goals of Phase 1:

  1. ROM 0-90°
  2. Adequate quad/VMO contraction
  3. Independent in HEP
  4. Control pain, inflammation, and effusion
  5. PWB to WBAT


Phase 2: Week 2-6 


Weekly Exercise Goals

  • 2-6 ROM 0-120° 
  • Passive, 0-120° 
  • Patellar mobs 
  • Ankle pumps Gastroc/soleus/hamstring stretch 
  • Prone hang if needed to reach goal Heel/Wall slides if needed to reach goal 

Strength

  • Multi-angle isometrics (0-60°) 
  • Quad sets with biofeedback 
  • SLR in a 4 planes 
  • Knee extension (90-10°) 
  • Heel raises/Toe raises 
  • Mini-squats (0-30°) 
  • Leg Press-single leg eccentric 
  • Multi-hip machine in 4 planes 
  • Reverse lunges-knee not to migrate over toe 
  • Lateral/Forward step-up/down 

Bicycle

  • May initiate bike when 110° flexion is reached 
  • DO NOT use bike to increase flexion 

Weight Bearing FWB

  • FWB with quad control 

Balance Training

  • Single leg balance with plyotoss 
  • Sports cord balance/agility work 
  • Wobble board work ½ 
  • Foam roller work 

Modalities

  • Ice 15-20 minutes

Goals of Phase 2:

  1. ROM 0-120°
  2. Adequate quad/VMO control
  3. Control pain, inflammation, and effusion
  4. Full weight bearing
  5. Increase lower extremity strength and endurance
  6. Enhance proprioception, balance, and coordination
  7. Complete readiness for sport specific activity


Phase 3: Week 6-12 


Weekly Exercise Goals

  • 6-12 ROM 0-135° 
  • Passive, 0-135° 
  • HS/Gastroc/Soleus stretch 
  • ITB/Quad stretch 
  • Patella mobs 

Strength

  • SLR in 4 planes with ankle wt/tubing 
  • Heel raise/Toe raise 
  • Leg Press-single leg eccentric 
  • Knee extension (90-10°) with resistance 
  • Lateral/Forward step-up/downs 
  • Reverse lunges-knee not to migrate over toe 
  • Hamstring curls with resistance (0-90°) 
  • Multi-hip machine in 4 planes 
  • Mini-squats with resistance (0-45°) 
  • Stool crawl 
  • Straight leg deadlift 

Balance Training

  • Two-legged balance board with plyotoss 
  • Initiate single leg steamboats with band 
  • ½ Foam roller work 
  • Wobble board work Sports cord single-leg agility/balance 

Aerobic Conditioning

  • Bicycle with resistance EFX/StairMaster 
  • Walking program 
  • Swimming (kicking) 

Running Program

  • Initiate running on minitramp, progress to treadmill when tolerable
  • Increase walking program 
  • Backward running 

Modalities

  • Ice 15-20 minutes as needed

Goals of Phase 3

  1. ROM 0-135°
  2. Full weight bearing with quad control
  3. Increase strength and endurance
  4. Control pain and swelling


Phase 4: Week 12-24


Weekly Exercise Goals

  • 12-24 ROM - Continue all stretching from previous phases

Strength

  • Continue all strengthening activities from previous phases increasing weight and repetitions 

Balance Training

  • Continue all single-leg activities increasing difficulty 

Running / Conditioning Program

  • Bicycle with resistance for endurance 
  • EFX/StairMaster for endurance 
  • Increase running program 
  • Increase walking program 
  • Swimming for endurance 
  • Backward running 

Cutting / Agility Program

  • Lateral shuffle Carioca Figure 8’s 

Functional Training

  • Initiate plyometric training 
  • Sport specific drills 

Modalities

  • Ice 15-20 minutes as needed

Goals of Phase 4:

  1. Increase and maximize function
  2. Maximize strength and endurance
  3. Return to previous activity level 
  4. Return to sport specific functional level


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