Platelet-Rich Plasma — PRP (Tendon/Ligament) Lower Extremity

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

NWB in boot with crutches or knee scooter Phase I; progress to FWB in protective device with AD Phase II; progress to FWB without AD Phase III

Key Restrictions

Avoid ALL NSAIDs (no iontophoresis) through Phase IV; limit/avoid ice through Phase IV; avoid eccentric exercises until Phase IV (pain <3/10); avoid compensatory movement patterns Phase III; 80% LSI required to progress to plyometrics/running/jumping/hopping/sport skills Phase IV

Timeline & Phases

Phase I, Tissue Protection (0-1 wk): NWB for lower extremity (boot with crutches or knee scooter), no weight training, avoid all NSAIDs (no iontophoresis), limit ice, minimize pain, improve/maintain ROM, relative rest, gentle AROM per procedure-specific handout, AD use to comply with WB status, Tylenol PRN; Phase II, Early Tissue Healing (1-2 wks): progress to FWB in protective device with AD, avoid eccentric exercises, avoid NSAIDs, limit ice, aerobic exercise allowed (avoid loading treated area), gentle stretching, proximal stability/strengthening (core for hip, shoulder for elbow, hip for knee, knee for ankle); Phase III, Facilitation of Collagen Deposition (2-6 wks): progress to FWB without AD, avoid eccentric exercise, avoid NSAIDs, avoid ice, full pain-free ROM, avoid compensatory movement patterns, low-weight high-rep isometrics, soft tissue work to treated area, dynamic stretching, joint mobilizations as needed, core strengthening, open kinetic chain strengthening and proprioceptive/balance activities (late stage, 5-6 wks post-procedure); Phase IV, Collagen Strengthening (6-12 wks): avoid NSAIDs/ice, improve strength, return to function, 80% LSI required to progress to plyometrics/running/jumping/hopping/sport skills, eccentric exercises if pain <3/10, closed kinetic chain exercises, plyometrics/proprioceptive training/sport-specific exercises, return to work/sport, resume full activity; Phase V, Return to Activity (3+ months): reassess improvement (consider repeat PRP if not >75% improved), return to work/sport, resume full activity, progress to functional sport-specific activities with increasing load as pain allows, max out eccentric exercises, may return to sport if pain <3/10

Notes

OSMS Rehabilitation Guidelines; PRP derived from centrifuged autologous venous blood delivering concentrated growth factors (platelet-derived growth factor, TGF-beta, VEGF) to stimulate healing and reduce inflammation; generic lower-extremity protocol covering hip/knee/ankle tendon and ligament injuries with proximal-to-distal kinetic chain strengthening emphasis; distinct from OSMS's upper-extremity PRP protocols by its weight-bearing progression structure

Published

2024-06