Quad Tendon or Patellar Tendon Repair PT Protocol

Extensor mechanism repair — therapist reference

Physical Therapy Protocols · From Dr. Allred · Transcribed from the printed sheet · 9 sections

Print this sheetPDF (opens in a new tab)All Physical Therapy Protocols

If you have questions about a protocol or a specific patient, call the clinic where the surgery was performed.

After hours & emergency numbers → Weekdays, business hours.

Jump to a section (9)

General Principles

  • Progression is criterion-based; timelines are approximate guidelines.
  • Avoid active knee extension for the first 6 weeks to protect the repair.
  • Begin patellar mobilization early to prevent adhesions; cryotherapy/elevation for edema; DVT prophylaxis; pain management as needed.

Phase 1 · Weeks 0–2 (Maximum Protection)

  • Brace locked in full extension for ambulation and sleep; WBAT with crutches, knee locked in extension.
  • ROM: passive flexion 0–45° (up to 90° if comfortable, no need to push); gravity-assisted passive extension; no active knee extension; patellar glides.
  • Quad sets, ankle pumps, SLR (brace locked) in hip flexion/abduction/adduction, gluteal sets.
  • Goals: wound healing, edema control, maintain full passive extension, independent transfers/ambulation with device.

Phase 2 · Weeks 2–6 (Early Motion)

  • Brace: unlock for ROM, lock in extension for ambulation; progress crutches → single crutch/cane.
  • Progressive passive flexion ~10–15°/week (0–60° by week 3; 0–90° by week 4). Continue patellar mobilization; no active knee extension against gravity.
  • Prone/gravity-assisted flexion; seated heel slides; stationary bike once ~90° (no resistance); multi-plane hip strengthening; core.
  • Goals: 90° passive flexion by week 4; maintain full extension; normalize gait in brace.

Phase 3 · Weeks 6–12 (Progressive Strengthening)

  • Discontinue brace (typically ~6 weeks, per surgeon); full weight bearing without a device.
  • Progress to full passive and active ROM; begin gentle active knee extension (short-arc quads 90–40°). Goal: full ROM by weeks 10–12.
  • Closed-chain (mini-squats, limited-arc leg press, low step-ups); bike with resistance; balance/proprioception; aquatic therapy; concentric quad program.
  • Goal: full ROM; quad strength ≥60% of the other leg.

Phase 4 · Weeks 12–20 (Advanced Strengthening)

  • Full unrestricted ROM. Progressive closed-chain (deeper squats, lunges, single-leg press); open-chain knee extension (light → full arc); eccentric quad program.
  • Reciprocal stair training; elliptical, swimming, walking; advanced balance/perturbation.
  • Goal: quad strength ≥80% of the other leg; normal stairs; pain-free functional activities.

Phase 5 · Weeks 20–24+ (Return to Activity)

  • Sport/occupation-specific training; plyometrics, agility/cutting (if applicable); running progression (walk/jog intervals); maintenance strengthening.

Return-to-Sport / Activity Criteria

  • Full, pain-free ROM; no effusion or pain with sport-specific activity.
  • Quadriceps strength ≥90% of the other leg; hop-test limb symmetry ≥90%.
  • Surgeon clearance.

Red Flags — Contact Surgeon

  • Sudden loss of active extension (possible re-rupture) or a palpable gap at the repair.
  • Significant increase in swelling/pain; wound drainage, erythema, or dehiscence; fever or signs of infection.

References

  • Rehabilitation Protocol for Quad and Patellar Tendon Repair. Lahey Hospital & Medical Center.
  • Patellar Tendon Repair Rehabilitation Guideline. Sanford Health.
Questions about this sheet? Call the clinic where the surgery was performed. I'm happy to talk through the plan. Numbers are at the top of this page, and every after-hours line is on the emergency numbers page.