NPTE common surgical procedures

Hand flexor tendon repairs

Distal extremity immobilization for 3–4 wk: protective splint, rubber band traction, IP joint in 30°–50° FLX

AROM at 4 wk; begin with EXT, then FLX

Hand extensor tendon repairs

DIP joints immobilized in neutral for 6–8 wk; AROM at 6 wk with PIP joints in neutral; begin with EXT

PIP joints immobilized with wrist and digits in EXT for 4 wk

AROM and PROM in FLX with MCP joint in EXT

Full AROM at 6 wk

Total hip replacement (cemented)

No IR, ADD, or FLX beyond

90° for 3–6 mo

• PWB for 3 wk

• Amb with cane at 4 wk

• FWB at 5 wk

Resisted exercises: week 4

Total hip replacement (uncemented)

No IR, ADD, or FLX beyond 90° for 3–6 mo

WBAT

• PWB for 3 wk

• Amb with cane at 4 wk

• FWB at 6 wk

TTWB

• One-third WB at week 6

• Two-thirds WB at week 8

• FWB with walker at week 10

Total knee replacement (cemented)

0°–90° within 2 wk

0°–120° within 3–4 wk

WBAT

• With walker initially

• With cane at week 3

• FWB at week 4

Resisted exercises: weeks 2 and 3

Total knee replacement (uncemented)

0°–90° within 2 wk

0°–120° within 3-4 wk

WBAT

• With walker initially

• With cane at weeks 5–6

• FWB at week 6

TTWB

• TTWB immediately

• WBAT with walker at week 6

• Cane at 8–10 wk

• FWB at week 10

ACL

NWB at week 1

Immediately postoperative: CPM 0°–70° FLX

Week 6: CPM 0°–120°

Hinged brace: 20°–70°; wean off at about weeks 2–4

Weakest at week 6

Meniscus: partial meniscectomy

Day 1: AROM

Day 3: Isotonic and isokinetic strengthening

Meniscus repair

NWB for 3–6 wk

Joint mobilizations

How soon to begin post op exercises after ACL surgery

immediately

NO OKC knee ext in long sitting —> stay within 90-45

Do CKC for stability

Avoid CKC quad strengthening bw 60-90 of flx

Hinged orthosis post ACL surgery worn up to _____ weeks. Locked in knee _____

6 weeks; locked in ext

able to unlock during ROM exercises

Locked w ambulation

Functional brace after ACL surgery used for advanced rehab weeks ____

11-24 weeks
For participation in high demand sports

Reduced anterior translation

Max protection phase weeks ____

1-4

Interventions wk 0-2

PRICE (bracing)

• Gait training with crutches; PWB to WBAT

• At week 1: WBAT with ROM as tolerated is ideal

• PROM, AAROM (range-limiting brace?): Prevent EXT lag (reflex inhibition)

• Grades I and II patellar mobilizations

• Muscle setting, isometrics: Can use ES or biofeedback

• Assisted SLR test (4-way)

Weeks 2-4 interventions

Progress to FWB: If active full knee EXT and pain-free; Adequate quadriceps strength

• CKC exercises (mini-squats, heel and toe raises)

• OKC knee EXT (90°–45° only)

• Trunk and pelvis stabilization

• Aerobic conditioning: stationary bike (3 wk)

Moderate protection phase are weeks _____

4-10

Week 5-6 interventions

Multiangle isometrics

• CKC strengthening and PRE: With OKC PRE; place resistance above knee until knee is stable

• Endurance training (bike, pool, elliptical)

• SLS: balance training

• Band walks, elastic band exercises

Weeks 7-10 interventions

Advanced strengthening, PNF

• High-speed step drills, unstable surfaces, balance beam

• Initiate walking and then jogging program

Minimum protection phase are weeks _____

11-24

Weeks 11-24 interventions

Advanced PRE, CKC strengthening: Emphasize eccentric contractions

• Initiate plyometrics

• Progress agility drills

• Simulated work and/or sports training

• Full-speed jogging, sprints, running and cutting