Quadriceps and Patella Tendon Repair Progression (12 weeks and up) | OEP373

We explore the final stages of rehabilitation for quadriceps and patellar tendon repairs, focusing on the progression from 12 weeks post-operation to full functional recovery. This episode completes our four-part series on tendon repair rehabilitation with practical guidance for therapists and patients navigating the return to higher-level activities.

• By 12 weeks, patients should have nearly full knee range of motion and natural gait on level surfaces
• Continue avoiding high-impact activities and forceful eccentric contractions
• Progress balance training from double to single leg, stable to unstable surfaces
• Advance cardiovascular training with stationary bike and elliptical
• Implement forward, backward and lateral walking with resistance for gait training
• Begin closed chain quad exercises with mini squats up to 70° knee flexion
• Carefully progress core exercises considering tension on the extensor mechanism
• Transition to higher activities around 4 months when meeting specific functional criteria
• Work on deceleration activities and controlled change of direction
• Progress from assisted hopping to full body weight jumping activities
• Take a more conservative approach with smokers or less active patients
• Be aware that quinolone antibiotics increase rupture risk during rehabilitation

If you're listening before May 31st, 2025 and interested in my upcoming live shoulder course in Auburn, Maine, check out the agenda on my website through the link in the show notes.

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Chapters

• 0:00 Introduction and Sponsor Highlights
• 1:33 12-Week Post-Op Status and Precautions
• 2:39 Balance and Gait Exercise Progressions
• 4:22 Close Chain Exercises and Core Work
• 6:39 Advancing to Higher Activity Levels
• 8:34 Safety Considerations and Final Thoughts

Transcript

Speaker 1: 0:00

Hello everyone and welcome to episode 373 of the World of the Southbound podcast.

Speaker 2: 0:04

I'm your host, paul Marci, and today we're going to be talking about what steps and potential attending and care progressions from 12 weeks and up. We're going to discuss our rehab goals on the stage activities to avoid at this stage, exercise recommendations and progressions to function so much more. Before we get started today, I'd like to mention our sponsors. We have Rangemaster.

Speaker 1: 0:22

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Speaker 2: 0:24

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Speaker 1: 0:28

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Speaker 2: 0:34

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Speaker 2: 2:08

Now here we are. We are at the 12-week post-op period. At this point patients should be pretty darn close to having full range of motion in the knee and should have close to natural gait on level surfaces, if not good, equal, symmetrical gait when they're walking on a level surface. Here's some precautions we want to talk about would be like avoiding lots of impact activities, especially forceful eccentric contractions. Also focus on good symmetry with movement. So what about exercise? Well, it's time to start with some balance drills, a little bit of weight shifting. Here we start with double leg work. Our time to start with some balance drills, a little bit of weight shifting. Here we start with double leg work, our way to single leg on a solid surface. We might go stable to less stable and then we might start with the knees in an extended position and then work our way into more of a flexed position. So, going from that stable to less stable surface, double to single and knees extended to knees flexed, really starting to work on that proprioception, okay, and there are many different ways you can work on balance. Just don't start to aggressively.

Speaker 2: 3:12

Get these people kind of confident. They're really rehabbing from this particular injury requires a lot of confidence, okay. So they don't have too much kinesiophobia as they're moving forward. They can be stationary biking. They definitely have enough range of motion now they can get onto an elliptical. It's a little more weight-bearing. It gets them bending that leg a little more naturally. I like it because it has almost kind of like a walking simulation. It keeps you in an upright posture and gets that cardio up there a little bit better. You know, just slowly work on increasing the resistance on both of them.

Speaker 2: 3:46

Now, as far as gait drills go, I like to work on forward backward lateral walking. I like to do resisted lateral walking almost, you know, really early with a full knee extension so you can really start to develop some glute med strength. I'll work into some short steps, shallow steps, and I'll work into something higher so that they're really kind of actively flexing the knee as they're stepping over. It might be a hurdle or a cone or something like that. You really want to work on functional movements now walking functional movements. From there we can start into some close kinetic chain quad exercises. So you can start mini squats like a shuttle or a leg press machine and you know you want to get to being upright vertical and squatting up to about 70 degrees of knee flexion till you get to about the four month mark. Then you can start working on multi directionaldirectional hip and core exercises.

Speaker 2: 4:41

Now remember your anatomy here. Okay, you can do a plank, a lateral plank on one side, do a lateral plank on the other side. That's not going to affect a patella or quad repair. But imagine you're doing a prone plank. Think about that. We have this really long lever. The quad is contracting hard and it's in a lot of tension. There's a lot of tension on that extensor mechanism. So think about the anatomy of that and think, well, is this too early for somebody? If you're questioning that, then maybe you start, you know, in the prone position, with a foam roll underneath the shins or maybe even up above the thigh a little bit, so they can start into, you know, a little bit of core stability with a plank. And then you progress with that foam roller going further and further down the shins and then you get to the toes without the foam roller, and then you progress from there.

Speaker 1: 5:32

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Speaker 2: 6:01

Once the patient has achieved full range of motion, they have good gait symmetry they're able to balance on one leg for 10 to 15 seconds and can squat down to about 70 to 80 degrees, then you can progress to a higher you know activity level around that four month mark. So here your goal is going to be to be able to have your patient do some sports, specific type activities or work specific type activities and control that eccentric load better. Okay, so you just start to work on deceleration activities. So maybe you get them. You're doing some light jogging at first and then you have them start and stop. So you go from forward jogging to retro jogging and you just teach them how to slow down with many steps rather than a real aggressive deceleration. And then you work on that change of direction. Maybe they start to do rotational activities, they start to work in diagonals. I like to get them doing very little hopping. Okay, maybe on a shuttle or a light leg press, something that is less than body weight, and then you go from double-legged, less than body weight, to full body weight standing and then you ultimately go from jumping on one leg, single leg on the same side. So let's say you have a left quad tendon, you can do a little single legged hopping and then you start to work from hopping from one leg to another so you're adding this little lateral movement with it, so you can then from there start to work into your higher level activities. This is where you really have to be creative. You know, patients may not be coming into therapy as long, but they're on a exercise program and then in the clinic you're just kind of working on progressions and starting to build them up so that they feel a little bit more confident if they're going to go back out and play sports or maybe even go back to work and, you know, do construction or do something where they do have to do a lot of climbing or squatting and getting down from the floor and getting back up.

Speaker 2: 8:06

So now I'm a little more conservative with these particular diagnoses of patellar tendon rupture and quad rupture. I'd rather progress them slower and steady, maybe have a little bit of weakness, maybe have a little bit of tightness, but have good tissue integrity, rather than push them too hard too early and end up re-injuring them, because fixing a re-rupture is never good and the integrity is not great. Knock on wood, I've never seen this happen before of batting 1,000 on these. A couple years ago actually we had three at the same time. Two of them we had discovered in our clinic. On one day they came in with basically knee contusion and knee pain. They both had quad ruptures and we rehabbed them and they did very, very well. So these people generally will do really well.

Speaker 2: 8:59

Something else I want you to take into consideration If the person is rehabbing with you and for some reason maybe they get sick, they need to take a quinolone antibiotic and for some reason maybe they get sick, they need to take a quinolone antibiotic. Remember, these antibiotics in this group can put you at high risk of rupture. So you really want to slow that program down, especially if you're working around the quads a lot. I would just kind of lighten that up a little bit while they're on the medication and just take a slower approach to this. The other thing to take into consideration is if your patient is a smoker or maybe they don't exercise regularly, that tissue integrity just isn't going to be as good. So, like I said, I'm a little more conservative with these folks and then I always try to chat with the surgeon about the integrity of the tissue before I get started with them and that way I know how to progress them a little bit better. I you know I might feel a little more confident progressing them faster if they have really good integrity and they were able to get a good purchase. You know when they put that patella tendon back together or quad sewed back together.

Speaker 2: 10:00

So I hope you enjoyed this series of podcasts. If it's something that you'd like to see more of, send me an email or click on the. Send me a text link in the show notes and I'll see what I can do. If you're listening to this podcast before May 31st 2025, and you're interested in my upcoming live shoulder course in Auburn, maine, go to my website, check out the agenda. I'll put a link in the show notes. You can check out the course content, see what the course consists of. If you want to register, by all means go ahead and do that. I'd love to see you there. Have a great day, folks. Be kind to each other and take care.