Quad / Patellar Tendon Repair — Knee Extensor Mechanism Repair

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

WBAT in locked brace x6 wks Phase I; weight bearing without TROM brace as quad function allows Phase II (begin weaning brace at 6 wks)

Key Restrictions

No active knee extension Phase I (quad sets in extension only); no loaded knee flexion Phase I; avoid knee hyperextension; ROM restrictions: 0-60 deg after 2 wks, 0-90 deg after 4 wks, unlimited flexion after 6 wks; avoid forceful eccentric quadriceps contraction Phase III

Timeline & Phases

Phase I (surgery-6 wks): achieve excellent hip/ankle ROM, reduce limb swelling, control pain, WBAT in locked brace x6 wks, no active knee extension (quad sets in extension only), no loaded knee flexion, avoid hyperextension, ROM progression (0-60 deg at 2 wks, 0-90 deg at 4 wks, unlimited at 6 wks), ankle pumps, isometric quad sets, glute/hip sets, gentle patellar mobilizations, 4-way leg lifts with brace locked in extension, UBE/upper body circuit; progress to Phase II after 6 wks if 0-90 deg knee PROM and only trace effusion; Phase II (6-12 wks): weight bearing without TROM brace as quad function allows, begin weaning brace at 6 wks, no ROM restrictions beyond 6 wks, short crank ergometry progressing to standard 170mm if knee ROM >115 deg, core strengthening, proprioceptive training, open chain hip strengthening, closed chain TKE 0-40 deg with mini squats/weight shift, treadmill walking, stationary/recumbent bike, Nordic Track/elliptical; progress to Phase III after 12 wks if knee PROM 0-130 deg and zero effusion; Phase III (12-26 wks): restore normal quadriceps control for walking, restore normal squats/presses, jogging and running, agility exercises (sport cord), avoid forceful eccentric quad contraction, active knee extension now permitted, add directional cutting/resistance, AROM open chain knee flexion/extension, prone knee flexion, patellar mobilization, isotonic knee extension (closed chain preferred), treadmill walking including resisted forward/retro walking, Versaclimber/Nordic Track, resisted cariocas, progressive light weights (3x10), single leg jumps including quadrant jumps, up to 100% full sprints; impact cardio allowed after 20 wks, return to sport after 20 wks if quad isometric strength >=85% of uninvolved side on Biodex

Notes

OSMS Rehabilitation Guidelines; covers patellar/quadriceps tendon rupture and patellar fracture repair; extensor mechanism connects thigh muscles to tibia for knee motion/strength at push-off