Quad tendon repair with allograft post-operative physical therapy protocol

General considerations

  • The surgical leg will be weight bearing as tolerated using crutches post-operatively.
  • Range of motion will be blocked at 0 degrees in a brace for 4 weeks.
  • No range of motion until 2 weeks, at 2 to 4 weeks 0 to 20 degrees. At 4 to 6 weeks 0 to 50 degrees.
  • Important not to push for flexion to quickly to protect the repair.
  • Avoid bandaged area and portals for 4 weeks, “no touch zone” 2 inches from portals.
  • Focus on proper quadriceps activation, especially VMO recruitment and patellofemoral mechanics should be the emphasis in the early stages of recovery.
  • Continue fitness through upper extremity, trunk, and cardiovascular exercise.

Week 1

  • M.D., office visit day 2 for dressing change, review of medications and instruction on a home program.

Exercises

  • Ankle pumps, quad sets, leg raises in multiple planes (except hip flexion).
  • Extension stretching to hamstrings, calves, and lateral musculature to maintain extension range of motion.
  • Well-leg stationary cycling and Upper Body Ergometer. Upper body weight machines and trunk exercises.
  • Gait training with crutches, pain and edema control, and muscle stimulation to improve quadriceps recruitment.

Manual

  • Soft tissue mobilization to surrounding musculature; effleurage for edema.

Goals

  • Decrease pain and edema.
  • Gait weight bearing as tolerated with brace locked in 0 degrees extension.
  • No Range of Motion.

Weeks 2 - 4

  • Nurse visit at 14 days post-operative for suture removal.

Exercises

  • Continue to progress weight bearing and functional mobility as able.
  • Active open chain hip extensions, adductions, abductions progressing to resistive band exercises as appropriate (proximal to the knee).
  • Standing calf raises. Straight legged bridging on ball with brace on.
  • Well legged cycling, upper body work outs.

Manual

  • Soft tissue mobilization surrounding structures, patellofemoral joint,and suprapatellar pouch with appropriate intensity to allow maturation and healing.

Goals

  • Decrease pain and edema.
  • Gait weight bearing as tolerated with brace locked in 0 degrees extension.
  • At 2 weeks okay to start 0 to 20 degree range of motionю

Weeks 4 - 6

  • M.D. visit at 1 month post-op. Wean out of brace, use brace unlocked if approved by MD.

Manual

  • Continue soft tissue mobilization. Initiate gentle patellar glides and portal scar tissue mobilization when appropriate.

Exercises

  • Ankle and hip resisted PNF patterns.
  • Single leg balance with perturbations (Around the worlds, single balance with upper extremity movements).
  • Prone on ball with added hip motions.
  • Continue well legged cycling and upper body work outs.

Goals

  • Range of motion 0 to 50 degrees.

Weeks 6 - 8

Exercises

  • Begin functional exercises such as partial squats, bent leg bridges, small range slider lunges, mini step ups.
  • Proprioceptive training. Continue to increase intensity and resistance of other exercises.
  • Two-legged bicycling for range of motion and without resistance and without forcing range of motion.
  • Emphasis on gait training with proper movement patterns.

Manual

  • Soft tissue mobilization through hip, knee, and lumbar region as necessary.
  • PNF patterns with resistance above the knee for hip and pelvic patterns.
  • Patellar decompression with taping techniques as needed.

Goals

  • Focus on gait mechanics. Range of motion 0 to 100 degrees.
  • Initiate stationary bicycle no resistance/pain.

Weeks 8 - 12

  • Initiate gentle passive flexion stretching to increase range of motion by 10 weeks.
  • Add lateral exercises (i.e. lateral stepping, lateral step-ups, etc.).
  • Continue all exercises with emphasis on closed-chain, functional and proprioceptive program. Increase unilateral closed chain activities. Increase resistance of cycling.

Goals

  • Passive/Active range of motion full, equal to opposite leg.
  • Gait no limp, good mechanics. Full range squat no pain. Stair management no pain.

Weeks 12 - 16

  • MD appointment at 12 weeks. Complete Sports test 1.
  • Goals are to increase strength, power, and cardiovascular conditioning.
  • Sport-specific exercises and training program. Eccentric focused strengthening program.
  • Begin gym strengthening including leg press. Increase proprioceptive drills.
  • Begin pre-running program (see handout for specific instructions) as able to demonstrate good strength and mechanics.

Months 4 - 6

  • Goals are to develop maximal strength, power, and advance to sporting activities.
  • Resisted closed-chain rehabilitation through multiple ranges.
  • Running program, balance drills and agility program.
  • Initiate plyometric training as able to demonstrate adequate strength and proper mechanics.

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.

Need help recovering from surgery? Our StoneFit Physical Therapy San Francisco team can help with customized, one-on-one programs to return you to full activity fitter, faster, and stronger than you’ve been in years.