How do I rehabilitate knee tendonopathy after surgery?

Rehabilitation Protocol for Knee Tendinopathy After Surgery

A comprehensive rehabilitation program combining strength and motor control training should be implemented immediately after knee tendinopathy surgery, with early mobilization and progressive weight-bearing within the first week to optimize recovery and prevent complications. 1

Early Postoperative Phase (First Week)

• Begin isometric quadriceps exercises immediately to reactivate the quadriceps muscles, provided they don't cause pain 2
• Implement immediate weight bearing with correct gait pattern in the first week, monitoring for pain, effusion or increased temperature 2, 1
• Apply cryotherapy in the first postoperative week to reduce pain and inflammation 2, 1
• Start immediate knee mobilization within the first week to increase joint range of motion, reduce knee pain and prevent complications like extension deficit 2, 1
• Consider neuromuscular electrical stimulation (NMES) as an addition to isometric strength training for re-educating voluntary contraction of the quadriceps muscles 2, 1
• Avoid continuous passive motion as it is not recommended by most guidelines 1, 2
• Postoperative functional bracing is generally not recommended unless specifically indicated by your surgeon 1, 2

Weeks 2-4

• Begin closed kinetic chain (CKC) exercises from week 2 postoperative 2, 1
• Progress from isometric exercises to concentric and eccentric exercises when the quadriceps is reactivated and the knee doesn't react with effusion or increased pain 2
• Continue supervised rehabilitation with a physiotherapist, though home-based rehabilitation may be suitable if you're highly motivated 2, 1
• Focus on restoring full knee extension range of motion as a priority to prevent long-term functional limitations 1, 2

Weeks 4-8

• Start open kinetic chain (OKC) exercises from week 4 postoperative in a restricted range of motion (ROM) of 90–45° 2, 1
• Gradually increase ROM in OKC exercises: to 90–30° in week 5, to 90–20° in week 6, to 90–10° in week 7, and to full ROM in week 8 2
• For patellar tendon repairs, avoid adding extra weight in the first 12 weeks to prevent graft elongation 2, 3
• Begin neuromuscular training alongside strength training to optimize outcomes and prevent reinjuries 2, 1

Beyond 8 Weeks

• Continue rehabilitation for 9–12 months, depending on your return-to-work or play goals 2, 1
• Measure quadriceps and hamstring strength regularly to track progress 1
• Evaluate psychological readiness for return to activities using validated instruments like ACL-RSI and Tampa Scale of Kinesiophobia 1
• For patellar tendinopathy specifically, eccentric exercises have shown the best evidence for long-term recovery 4, 5

Return to Running Criteria

• Achieve 95% knee flexion range of motion 1
• Restore full extension range of motion 1
• Have no effusion or only trace effusion 1
• Achieve Limb Symmetry Index (LSI) >80% for quadriceps strength 1
• Demonstrate LSI >80% eccentric impulse during countermovement jump 1
• Perform pain-free repeated single-leg hopping exercises 1

Return to Sport/Full Activity Criteria

• No pain or swelling 1
• Full knee range of motion 1
• Stable knee joint 1
• Normalized subjective knee function and psychological readiness 1
• Quadriceps and hamstring strength symmetry of 100% for return to high-demand pivoting sports 1
• Countermovement jump and drop jump >90% symmetry of jump height and concentric/eccentric impulse 1
• Normalized jumping biomechanics with >90% symmetry in vertical and horizontal jumps 1
• Restored running mechanics with >90% symmetry of ground reaction forces 1
• Completion of a sports-specific training program 1

Common Pitfalls to Avoid

• Delaying mobilization can lead to stiffness and extension deficits 2, 6
• Failing to address quadriceps strength deficits significantly impacts long-term functional outcomes 2, 1
• Progressing too quickly with open kinetic chain exercises can compromise healing 2, 3
• Neglecting neuromuscular training alongside strength training increases reinjury risk 2, 1
• Discontinuing rehabilitation too early (before 9-12 months) compromises optimal functional recovery 2, 1
• For patellar tendinopathy specifically, failing to address biomechanical factors like ankle and hip mobility can lead to recurrence 3, 7