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Dr. Vonda Wright MD

Orthopedic Surgeon

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MCL PT Protocol

POST-OP DAYS 1 —14

  • Dressing:
    • POD 1: Debulk dressing, TED Hose in place
    • POD 2: Change dressing, keep wound covered, continue TED Hose
    • POD 7-10: Sutures out, D/C TED Hose when effusion resolved
  • Brace x 8 weeks — Locked in extension for ambulation
  • Crutches — Partial weight bearing (PWB) in brace (no more than 50% of body weight)
  • Patellar mobilization (teach patient)
  • Calf pumping
  • AAROM, AROM 0-90 degrees
  • Passive extension with heel on bolster or prone hangs
  • Electrical stimulation in full extension with quad sets and SLR
  • Quad sets, Co-contractions quads/hams
  • Straight leg raise (SLR) x 3 on mat in brace — No ADD
  • Short arc quads
  • No stationary bike x 6 weeks
  • Ice pack with knee in full extension after exercise

GOALS

  • Pain/effusion control
  • Good quad control

Weeks 2 - 4

  • Brace x 8 weeks — Open to 0-45 degrees
  • Crutches — PWB in brace
  • Continue appropriate previous exercises
  • Scar massage when incision healed
  • AAROM, AROM 0-90 degrees only
  • Total Gym for ROM (level 1-3)
    • Passive flexion to 90 degrees (push up with opposite leg)
  • SLR x 3 on mat, no brace if good quad control — No ADD
  • Double leg heel raises
  • No stationary bike x 6 weeks
  • Stretches — Hamstring, Hip Flexors, ITB

GOALS

  • ROM 0-90 degrees
  • No extensor lag

WEEKS 4 - 6

  • Brace x 8 weeks — Open to 0-90 degrees
  • Crutches — PWB in brace
  • Continue appropriate previous exercises
  • AAROM, AROM 0-120 degrees
  • Standing SLR x 3 with light Theraband bilaterally
    • May begin Hip ADD with Theraband if good LE control in full extension
  • Total Gym (level 3-5)— Mini squats 0-45 degrees
    • Passive flexion to 90 degrees (push up with opposite leg)
  • Leg press 0-45 degrees with resistance up to V4 body weight
  • Hamstring curls 0-45 degrees — Carpet drags or rolling stool (closed chain)
  • No stationary bike x 6 weeks

GOALS

  • ROM 0-120 degrees
  • No effusion

WEEKS 6 - 8

  • Brace — Open to full range
  • Crutches — Weight bearing as toterated(WBAT), D/C crutch when gait is normal
  • Continue appropriate previous exercises
  • PROM, AAROM, AROM to regain full motion
  • Standing SLR x 4 with light Theraband bilaterally
  • Wall squats 0-45 degrees
  • Leg press 0-60 degrees with resistance up to 1/2 body weight
  • Hamstring curls through full range — Carpet drags or rolling stool
  • Forward, lateral and retro step downs in parallel bars
    • No knee flexion past 45 degrees (small step)
  • Proprioceptive training
    • Single leg standing in parallel bars
    • Double leg BAPS for weight shift
  • Single leg heel raises
  • Treadmill — Forwards and backwards walking
  • Stationary !Ace — Progressive resistance and time
  • Elliptical trainer

GOAL

  • Full ROM

WEEKS 8 - 12

  • D/C Brace
  • Continue appropriate previous exercises with progressive resistance
  • Leg press 0-90 degrees with resistance as tolerated
  • Hamstring curls on weight machine
  • Knee eqnsion weight machine
  • Forward, lateral and retro step downs (medium to large step)
  • Proprioceptive training — Single leg BAPS, ball toss and body blade, Grid exercises
  • Treadmill — Walking progression program
  • Stairmaster — Small steps
  • Pool therapy

GOAL

  • Walk 2 miles at 15 min/mile pace

MONTHS 3 - 4

  • Continue appropriate previous exercises
  • Fitter
  • Slide board
  • Functional activities — Figure 8s, gentle loops, large zigzags
  • Treadmill — Running progression program
  • Pool therapy — Swimming laps
  • Quad stretches

GOAL

  • Run 2 miles at easy pace

MONTHS 4 - 6

  • Continue appropriate previous exercises
  • Agility drills / Plyometrics
  • Sit-up progression
  • Running progression to track
  • Transition to home / gym program

GOAL

  • Return to all activities

*NO CONTACT SPORTS UNTIL 6 MONTHS POST-OP*

KNEE POST-OP PHASE I

Perform exercises below frequently: 30 reps, 3 — 5x a day

Quad Isometrics

Heel Slides

Active Assisted Motion

Ice Position 15 minutes 2-3 x per day

Leg Stretch
Leg Position
Leg Movement
Cool The Muscle

My Other Surgical Specialties

  • Shoulder Surgery
    • Rotator Cuff Repair
    • Subacromial Decompression (SAD) / Distal Clavicle Resection (DCR)
    • Shoulder Instability
  • Hip Surgery
    • Hip Arthroscopic Surgery
    • Rehab Protocols for Hip Surgery
  • Knee Surgery
    • Meniscus
    • ACL
    • MPFL

Books

About

Orthopaedic Surgeon, Author, Speaker and "The Mobility Doc," Dr. Vonda Wright is an internationally recognized authority on active aging and sports medicine.

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