Beginner Knee Post-Surgical Rehabilitation

Wound healing progressing without signs of infection at surgical incision sites,Joint effusion (swelling) decreased to mild (< 25% increase in knee circumference),Quadriceps activation achieved with ability to perform quad sets with palpable quadriceps contraction,Weight bearing status as prescribed by surgeon (typically touchdown weight bearing or non-weight bearing),Pain controlled at ≤3/10 at rest with prescribed medications,ACL/PCL graft integrity maintained - no signs of graft failure (negative Lachman test, no abnormal pivot shift)

→ Advance to: Phase II - Early Motion

Surgical incisions healing by primary intention, sutures/staples intact,Knee ROM achieved: 0-45° flexion with no pain at graft site,MCL/LCL healing status confirmed - no valgus/varus laxity on stress testing,Meniscus repair status - if repaired, compliance with meniscus protection protocol (no flexion beyond 90° for first 6 weeks),Patellar mobility restored - patella able to glide medially/laterally without restriction,No signs of complex regional pain syndrome (no disproportionate pain, skin changes, or temperature asymmetry)

→ Advance to: Phase II - Early Motion

Knee ROM: 0-75° flexion achieved without pain,Quadriceps strength: able to perform straight leg raise without quadriceps lag,Weight bearing progressed to partial weight bearing (25-50% body weight) as tolerated,Cartilage healing - if microfracture or repair performed, no impact loading permitted,Patellar tendon mobility - no patellar tendon adherence or crepitus,Hamstring activation achieved - able to perform hamstring sets with palpable contraction

→ Advance to: Phase III - Strengthening

Knee ROM: 0-90° flexion achieved,Full extension equal to contralateral knee achieved (0° extension),Weight bearing progressed to weight bearing as tolerated with assistive device,Quadriceps strength: able to perform active knee extension from 90° to 0° without lag,No increased joint effusion with increased activity level,MCL/LCL stability confirmed - grade I or less valgus/varus laxity with stress testing

→ Advance to: Phase III - Strengthening

Knee ROM: 0-110° flexion achieved,Quadriceps strength: able to perform 10 consecutive straight leg raises without fatigue,Weight bearing: full weight bearing achieved without assistive device or with single crutch as needed,Meniscus status - if repaired, cleared for progression beyond 90° flexion based on surgical protocol,Cartilage: no pain with weight bearing activities, no crepitus with ROM,Hip and ankle strengthening initiated - hip abduction strength 4/5, ankle dorsiflexion/plantarflexion 4/5

→ Advance to: Phase IV - Advanced Strengthening

Knee ROM: 0-120° flexion achieved,Quadriceps strength: manual muscle testing quadriceps ≥3+/5,Patellofemoral tracking - no patellar apprehension or crepitus with knee extension,Balance: able to stand on affected limb with minimal support for 30 seconds (eyes open),No increased swelling after therapy sessions or activity,Gait pattern normalized - no antalgic gait pattern, adequate heel strike and push-off

→ Advance to: Phase IV - Advanced Strengthening

Knee ROM: 0-125° flexion achieved,Quadriceps strength: able to perform mini squats (0-45° knee flexion) without pain,Hamstring strength: able to perform hamstring curls with resistance (ankle weight or resistance band),Balance: able to stand on affected limb for 60 seconds with eyes closed (progressing to unstable surface),Proprioception: joint position sense within 5° of contralateral knee,Cardiovascular endurance: able to perform stationary bike for 15 minutes at low resistance

→ Advance to: Phase IV - Advanced Strengthening

Knee ROM: 0-130° flexion achieved, approaching full ROM,Quadriceps strength: isokinetic quadriceps strength at 60°/sec ≥50% of contralateral limb,Patellar strength: able to perform terminal knee extension against resistance without anterior knee pain,Hamstring strength: hamstring curl strength ≥60% of contralateral limb,Functional movement: able to perform step-up (4-inch step) without deviation or pain,No exacerbation of symptoms with activities of daily living

→ Advance to: Phase IV - Advanced Strengthening

Knee ROM: within 10° of contralateral knee (typically 0-135°+),Quadriceps strength: single leg squat (0-60° knee flexion) with good control, no valgus collapse,Hamstring strength: Nordic hamstring exercise (if cleared by surgeon) or heavy resistance hamstring curls,Balance: single-leg stance on unstable surface (foam, BOSU) for 30 seconds with eyes closed,Plyometric progression: double-leg hops in place, no pain, good landing mechanics,Patellofemoral loading: no anterior knee pain with resisted knee extension against gravity

→ Advance to: Phase V - Return to Activity

Quadriceps strength: isokinetic testing at 60°/sec ≥65% of contralateral limb,Hamstring strength: bilateral hamstring strength ≥70% of contralateral limb,Functional testing: single-leg hop for distance ≥70% of contralateral limb,Cardiovascular: able to perform 20 minutes continuous cycling at moderate resistance,No joint effusion with increased activity level,LCL/MCL stability: stable to varus/valgus stress at 0° and 30° knee flexion

→ Advance to: Phase V - Return to Activity

Quadriceps endurance: able to perform 20 consecutive single-leg squats without fatigue,Proprioception: bilateral limb comparison on balance testing within 15%,Functional agility: able to perform lateral shuffles, Carioca, backward walking without pain,Core stability: able to maintain plank for 60 seconds with good form,Patellar tracking: no patellar tilt or lateral shift with active knee extension,No recurrence of effusion with sport-specific or functional activities

→ Advance to: Phase V - Return to Activity

Quadriceps power: vertical jump height ≥70% of contralateral limb (if cleared),Agility: ability to perform figure-8 running at 50% speed without pain or instability,Sport-specific movements: able to perform sprint start drills at reduced intensity,ACL/PCL graft maturation: timeline appropriate (typically 9+ months for full return, but progressions begin earlier),Patient-reported outcome scores: IKDC, Lysholm, or KOOS showing improvement from baseline,Psychological readiness: readiness for return to sport questionnaire indicating confidence

→ Advance to: Phase V - Return to Activity

Full ROM achieved equal to contralateral knee,Quadriceps strength: isokinetic at 60°/sec ≥70% of contralateral limb, limb symmetry index ≥80%,Functional testing: single-leg hop test ≥80% of contralateral limb, triple hop ≥80%,No episodes of giving way or instability with functional activities,Patellofemoral symptoms: no anterior knee pain with loaded knee flexion activities,Cleared by surgeon for advancement to higher-level activities based on surgical findings and healing timeline

→ Advance to: Maintenance/Discharge