Patella Tendon Reconstruction Rehabilitation Protocol
The recommended rehabilitation protocol for patella tendon reconstruction should include immediate knee mobilization within the first week, progressive strength training starting with isometric exercises, and a gradual return to functional activities based on objective criteria rather than strict timelines. 1
Phase 1: Initial Phase (0-4 weeks)
- Immediate knee mobilization should be implemented within the first week to increase joint range of motion, reduce pain, and prevent soft tissue-related adverse events such as extension deficit 2, 1
- Initiate isometric quadriceps exercises from the first postoperative week if not causing pain, including static quadriceps contractions and straight leg raises 2, 1
- Apply cryotherapy immediately after surgery to reduce knee pain without increasing risk of short-term adverse events 2, 1
- Consider neuromuscular electrostimulation in addition to isometric strengthening in the initial weeks to re-educate voluntary contraction and increase quadriceps strength 2, 1
- Weight-bearing should be progressed as tolerated, with early weight-bearing (within first week) encouraged but individualized based on surgical procedure 2
- Postoperative knee bracing is generally not recommended for routine use following patella tendon reconstruction 2, 3
Phase 2: Intermediate Phase (4-7 weeks)
- Prioritize closed kinetic chain exercises during the first postoperative month to mitigate the risk of patellofemoral pain 2, 1
- Open kinetic chain exercises (90-45°) can be added as early as 4 weeks, but without extra weight in the first 12 weeks if hamstring graft was used 2, 1
- Progress from isometric to concentric and eccentric strengthening exercises in closed kinetic chain positions 2, 1
- Combine strength training with neuromuscular and motor control re-education exercises for better functional outcomes 2, 1
Phase 3: Advanced Phase (7-12 weeks and beyond)
- Progress gradually to more demanding activities based on functional criteria rather than strict timelines 1
- Implement comprehensive functional testing to assess strength and movement quality before allowing return to sports activities 1
- Consider the addition of eccentric training programs which have shown benefits in tendon rehabilitation 4
- For patients with hamstring tendon grafts used in reconstruction, special attention should be paid to hamstring strengthening 5
Important Considerations
- Early mobilization has shown similar or better outcomes compared to delayed mobilization protocols in patella tendon repair 6
- Monitor pain and inflammation carefully during exercise progression 1
- Evaluate both quality and quantity of movement during rehabilitation 1
- Be aware that most patients may not be ready for high-intensity sports activities even at 8 months post-surgery 1
- A supervised rehabilitation program is recommended for most patients, though home-based rehabilitation may be suitable for highly motivated patients who live far from physical therapy services 2
Common Pitfalls to Avoid
- Delaying mobilization can lead to arthrofibrosis and prolonged recovery 2, 1
- Progressing too quickly with open kinetic chain exercises, especially with hamstring grafts, may compromise healing 2
- Focusing solely on strength while neglecting neuromuscular control and proprioception 2, 1
- Relying on time-based rather than criteria-based progression through rehabilitation phases 1
- Neglecting to address quadriceps atrophy, which is common following patella tendon injuries 7, 5