NON-OPERATIVE PHYSIOTHERAPY PROTOCOL OF MENISCAL INJURY:

PHASE I WEEK 0-1

AIM To reduce swelling
Maintain ability to extend the knee
Knee flexion over 90ᵒ
Cryotherapy For 15 minutes after every couple of hours to reduce swelling
Compression To reduce swelling to be worn for 24 hours/day.
bandage / knee  Initial 1-2 days during complete rest a simple elastic knee sleeve is used.
support  Later on hinged knee brace is used to protect the medial knee ligaments
and cartilage while initiating walking.
Electrotherapy To reduce pain and inflammation
modalities e.g. Ultrasound, TENS, IFT
Exercises Gentle ROM exercises within limits of pain
Isometric or static quadriceps exercises
Double leg calf raises, hip abduction and extension
Resistance band hamstring exercises
Static cycling to maintain aerobic fitness

PHASE II WEEK 1-2

AIMS To eliminate knee swelling
Achieve full knee ROM
Continue Cryotherapy , knee support and electrotherapy modalities
Exercises Same as above
Closed chain exercises of lower limb
 Squats and lunges if pain allows
 Leg press initially bilaterally and gradually unilaterally
 Step up
 Hip bridges
Proprioceptive exercises: wobble board balance drill

PHASE III WEEK 2-3

AIMS Regain full knee ROM
Regain normal muscle strength
Return to ADLs
Knee support Discontinue/ not needed
Exercises Same as above
Running, swimming, road cycling
Plyometrics
Backward running, jumping, hopping and kicking
POST OPERATIVE REHABILITATION PROTOCOL OF MENISCAL INJURY:

PHASE I MAXIMUM PROTECTION PHASE : WEK 1-6

Stage 1 Immediate postoperative : Day 1-Week 3
Rice therapy
Electrical muscle stimulation
Brace locked at 0ᵒ
ROM exercises ROM 0-90ᵒ
 Motion limited for first 7-21 days
 Gradual increase in flexion ROM as per pain allows
Mobilization Patellar mobilization
Scar tissue mobilization
Strengthening Quadriceps isometrics
exercises
Hamstring isometrics (when posterior horn is repaired then no hamstring exercise
for 6 weeks)
Hip abduction and adduction
Weight bearing WBAT with crutches and brace locked at 0ᵒ
Proprioceptive
exercises

Stage 2 Progressive resistance exercises

Limited range knee extension
Toe raises
Mini squats
Cycling
Flexibility exercises

PHSE II MODERATE PROTECTION PHASE : WEEK 6-10

Goals To increase strength, power and endurance
To regain full ROM of knee
Exercises Same as above
Lateral step ups
Endurance Swimming, cycling, stair climbing
exercises
Co-ordination Balance board
exercises
Backward walking
Plyometrics

PHASE III ADVANCE PHASE WEEK 11-15

Goals Increase power and endurance
Return to ADLs.
Exercises Same as above
Full ROM exercises
Initiate running programs
NON-OPERATIVE PHYSIOTHERAPY PROTOCOL FOR ACL INJURY:

PHASE I MOTION AND PROTECTION

Goals To decrease pain and edema
To increase strength of muscles
To maintain ROM
To improve patellar mobility
Independent ambulation
To reduce pain & RICE Therapy
swelling
US, TENS, IFT or EMS
Ankle pumps
Strengthening Isometric of quadriceps, hamstring, hip abductors, adductors, abdominals and
exercises quadratus lumborum
Electrical stimulation to VMO and quadriceps
ROM Patellar mobilization
PROM/AROM
Stretching Stretching of quadriceps, hamstring, hip flexors, ITB, calf muscles
CCE Light close chain exercise e.g. mini squats
Proprioceptive Initiate neuromuscular control and proprioceptive exercise
exercise

PHASE II MOTION AND CONTROL

Same as above
Wear brace for functional activities
CKCE Progress CCE: step ups, leg press, theraband kicks
OKCE Initiate open kinematic chain exercise with precaution as it may cause
excessive anterior translation of tibia on femur

PHASE III STRENGTH AND PROPRIOCEPTION

Goals Pain free and complete AROM
Normal strength of VMO
Less than 20% quadriceps deficit
Treatment Same as above
Eccentric exercises of quadriceps and hamstring muscles
Progress proprioceptive exercises
Balance and coordination exercises

PHASE IV STRENGTH, FUNCTION AND ENDURANCE

Goals Less than 10% strength deficit and proper hamstring / Quadriceps ratio
Treatment Same as above
Progressive resistance exercises
Light plyometrics
Forward and backward step over
POST-SURGICAL REHABILITATION PROTOCOL OF ACL INJURY:
PHASE I WEEK 0-2
Goals Protect graft fixation
Reduce pain and inflammation
Achieve full knee extension and 0-90ᵒ knee flexion
Brace Drop lock brace locked in extension for ambulation and sleeping
WB WBAT with 2 crutches
Discontinue crutches as tolerated after 7 days
Exercises RICE therapy
Heel slides, wall slides
Quadriceps and hamstring sets
Patellar mobilization
NWB gastrocnemius and hamstring stretch
SLR with brace in full extension until quadriceps strength is sufficient to
prevent extensor lag
Prone leg hangs

PHASE II WEEK 2-6

Goals Restore normal gait
Restore full ROM
Protect graft fixation
Improve strength, endurance and proprioception
Brace Discontinue after 4 weeks
WB Patellar tendon graft: Continue ambulation with brace locked in extension,
may unlock for sitting and remove brace for ROM exercises
Hamstring graft: may discontinue the brace as quadriceps control is achieved.
Exercises Mini squats 0-30ᵒ
Stationary bike
CKCE : leg press 0-30ᵒ
Toe raises
Continue stretches and prone hangs

PHASE III WEEKS 6-8

Goals Avoid overstressing of graft fixation
Protect patellofemoral joint
Progress strength and proprioception
Exercises Patellar mobilization
CKCE: one leg squat, Leg press 0-60ᵒ
Stair climbing: step up and down
Plyometrics
Proprioceptive exercises: trampoline, wobble board balance

PHASE IV WEEK 8-12

Goals Return to ADLs
Exercises Continue and progress strength and flexibility program
Proprioceptive exercises
Plyometrics
Lunges
Cross over walking-agility drills
NON-SURGICAL PHYSIOTHERAPY PROTOCOL OF PCL INJURY:

PRECAUTION Avoid more than 90ᵒknee flexion for first 6 weeks post injury.
Posterior knee pain indicates that progression is too quick
PHASE I DAY 0-10
ROM 0-60 Degrees
To reduce swelling Ice, elevation, NSAIDS
WB/Gait Protected WB (50%) with crutches
Exercises Isometric quadriceps as pain permits
AVOID Avoid open chain hamstring strengthening exercises

PHASE II DAY 10-21

ROM Early ROM within limits of pain
Active assisted and passive range of motion less than 60 Degrees
To reduce swelling Ice, elevation, NSAIDS
WB/Gait WBAT with knee brace locked in extension
Discontinue crutches when patient is able to and swelling is controlled
Exercises Isometric quadriceps when pain permits
Leg press 0-60 degrees
AVOID Avoid open chain hamstring strengthening exercises
Avoid posterior subluxation by placing a pillow under posterior aspect of
lower leg when lying down

PHASE III WEEK 3-5

ROM Progress as tolerated
To reduce swelling Ice, elevation, NSAIDS, electrical stimulation
WB/Gait WBAT
Discontinued the large hinged knee brace as tolerated
Obtain a functional PCL brace
Exercise/Functional Increase strength and endurance of quadriceps
training
Open chain knee extension exercises allowed only when no patellofemoral
symptoms present
Quadriceps sets and terminal knee extension
Hip extension with knee extension
No hamstring exercise with flexed knee
Mini squats 0-60ᵒ
Leg press 0-60ᵒ

PHASE IV WEEK 5-8

ROM Progress as tolerated
Gait/WB WBAT
Exercise/Functional Closed chain exercises to improve functional strength
training e.g. Mini squats, Wall slides, steps up , leg press
Progressive resistance exercises of quadriceps
Proprioceptive exercises: Slide board
POST OPERATIVE PHYSIOTHERAPY PROTOCOL OF PCL INJURY:

PHASE I IMMEDIATE POSTOPERATIVE : WEEK 0-2

GOAL Control swelling & inflammation
Obtain full passive extension
Gradually increases the flexion to 90ᵒ
Patellar mobility
To reduce swelling Ice and elevation
Brace Wrap locked at 0ᵒ knee extension for ambulation and sleep only from 4th day
onwards
WB As tolerated with 2 crutches (50%)
ROM PROM (0-90ᵒ of knee flexion) out of brace.
EXERCISES Patellar mobilization
Stretching of hamstring and calf muscles
Ankle pumps
Quadriceps sets
SLR for hip flexion, abduction and abduction
Knee extension 60-0ᵒ
EMS To quadriceps during quadriceps sets
CPM 0-60ᵒ as tolerated

PHASE II MAXIMUM PROTECTION WEEK 2-6

GOALS Control extension forces to protect graft
Restore motion
Nourish articular cartilage
Decrease swelling and fibrosis
Prevents quadriceps atrophy
WEEK 2
Brace Wrap locked at 0ᵒ knee extension
WB As tolerated with 1 crutch
ROM PROM (0-90ᵒ of knee flexion) out of brace.
Exercises Multiangle isometrics 60,40,20ᵒ
Quadriceps sets
Knee extension 60-0ᵒ
Leg press 0-60ᵒ
EMS To quadriceps during quadriceps sets
CPM 0-60ᵒ as tolerated
WEEK 3
Brace Wrap locked at 0ᵒ knee extension
WB Full WB, No crutches
ROM PROM (0-100ᵒ of knee flexion) out of brace.
Exercises Mini squats 0-45ᵒ
Wall squats 0-50ᵒ
Knee extension 60-0ᵒ
Static cycling for ROM and endurance

PHASE III CONTROLLED AMBULATION–WEEK 4-5

Goals Restore full ROM
Improve quadriceps strength
Restore proprioception
 Discontinue knee immobilizer
Quadriceps strength 70% of contra lateral side
Decrease joint effusion
ROM PROM (0-120ᵒ)
Exercises Knee extension 60-0ᵒ
Leg press 0-75ᵒ
Lateral step ups
Front and side lunges
Heel toe raises
WEEK 6-10
ROM PROM 0-130ᵒ

PHASE IV LIGHT ACTIVITY Months 3-4

Goals Develops strength, power and endurance
Begin to prepare for return to functional activities
Exercises Begin light running program
Agility drills
Initiate plyometrics