Kristen A. Herbst, DO
Orthopaedic Surgeon—Sports
Medicine Specialist
1 Brace Road, Suite B
QUADRICEPS/PATELLAR TENDON REPAIR
Cherry Hill, NJ 08034
P: 856-470-9029 | F: 856-428-4053
This procedure involves the repair of a torn or ruptured tendon through
open debridement and suturing of disrupted tissues and re-establishing
the connection to the patella.
805 Cooper Road, Suite 2
Voorhees, NJ 08043
P: 856-882-1201| F: 856-424-2218
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Goals
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Restore motion
Restore lower extremity control
Maintain knee stability
Protect healing tissue
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Rehabilitation Principles
o Patient progression is time and function based and any deviation from clinical
guidelines should be relayed to physician and documented.
o Initiate early weight-bearing and ROM with heavy emphasis on obtaining full, early
extension but protecting excessive flexion.
o Limit muscular inhibition and atrophy from effusion.
o Initiate early activity of quads and hamstrings (isometric, isotonic, resistive) with estim and biofeedback.
o Address limb confidence issues with progression of unilateral activity
o Address limb velocity issues during gait with verbal and tactile cueing
o Incorporate comprehensive lower extremity (hip and calf) muscle stabilization and
strengthening activities as well as core strengthening activities
o Initiate early proprioceptive and kinesthetic techniques: Low to high, sagittal to
frontal, bilateral to unilateral, stable to unstable, slow to fast, fixed to unfixed surface
o Constantly monitor for signs and symptoms of patellofemoral irritation.
o Encourage life-long activity modification to include low impact cardiovascular activity
and patellofemoral protection strategies (especially those found to have CMP at
surgery).
o Incorporate sports-specific performance into rehab.
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Post op functional guidelines
o Driving
▪ No research to support recommendations for return to driving
▪ Typically 7-14 days for left leg
▪ Refer patient to drug precautions
▪ Refer patient to auto insurance coverage
▪ Dependent on
• extremity involved
• adequate muscle control for braking and acceleration
• proprioceptive/reflex control
• adequate, functional ROM to get into driver’s side
• confidence level
o Work
▪ Sedentary up to 2-4 weeks
▪ Medium to high physical demand level 16+ weeks
o Jogging on the treadmill
▪ 16 weeks as strength and function dictates
▪ Observe and minimize limb velocity asymmetry
▪ Encourage lower impact activity
o Hopping
▪ Bilateral low amplitude
• No earlier than 12th week
▪ Unilateral low amplitude
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• No earlier than 14th week
Bilateral
Moderate amplitude
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• No earlier than 14th week
▪ Unilateral Moderate amplitude
• No earlier than 16th week
▪ Bilateral Large amplitude
• No earlier than 16th week
▪ Unilateral Large amplitude
• No earlier than 20th week in GAP
Straight plane agility activity
▪ No earlier than 10th week
Agility with cutting
▪ No earlier than 12th week in GAP
Sports specific cutting and rotational activity (supervised by a professional in
GAP)
▪ check physician preference
▪ no earlier than 16th week and in functional brace
Sports
▪ Golf - 16 weeks
• Encouraging backward golfing
• Warm up properly with stretching
▪ All other sports - 6 months
• Dependent upon good quad control, full range of motion, >80%
score on hop test, and 80% isokinetic score (when ordered,
recommended or appropriate)
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Post op equipment guidelines
o Post-op Brace
▪ Locked in full extension for ambulation for 6 weeks
▪ 0-45 degrees for weeks 0-2
▪ 0-90 degrees for weeks 2-4
▪ 0-120 4-6 weeks
▪ DC brace at 6-8 weeks as quad function dictates
o Crutches
▪ 2 crutches for 2-4 weeks, then 1 crutch until gait is normalized
▪ Dependent upon adequate quad control, no observed gait deviations, no
change in pain, swelling, or effusion
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Clinical Restrictions
o No active knee extension for 4 weeks
o No deep knee bend under body weight for 6 months
o No extension lag when out of brace
Rehabilitation for Quadriceps Tendon Repair
o Weeks 1-2
▪ Rehab Guidelines
• control post-op pain and swelling
• ROM – Full extension to 45 degrees of knee flexion
• inhibit post-op muscle shut down (e-stim, biofeedback,, verbal/tactile cueing)
• SLR flexion without lag, 4 way SLR
• progress comprehensive, lower-extremity stretching program
• progress hip, calf and core strengthening activities
▪ Rehab Expectations by the end of week 2
• ROM: 0 º to 45º
• Visible quad contraction (rated fair- to fair) (home stim if poor)
• Independent straight leg raise without extensor lag
o Week 2-4:
▪ Rehab guidelines
• control post-op pain and swelling
• ROM – Full extension to 90 degrees of knee flexion
• normalize patellar mobility
• hamstring curls to 45 degrees with light resistance
• progress closed-chain activity like multi direction weight shifts and small
amplitude stepping to improve limb confidence
• progress comprehensive, lower-extremity stretching program
• progress hip, calf and core strengthening activities
▪ Rehab Expectations by the end of week 4
• ROM: 0º to 90º
• quad contraction (fair to good) (home stim unit if poor)
• Independent straight leg raise without extensor lag
o Week 4-8:
▪ Rehab guidelines
• ROM progressed to 120 degrees of knee flexion
• full revolution on bike
• begin active knee extension
• progress bilateral and unilateral, closed chain activity to improve limb
confidence including mini squats, wall squats, light resistance leg press
▪ Rehab Expectations by the end of week 8
• ROM: 0º extension without guarding to 120º
• Quad 4-/5
• Ambulation without deviation and assistive device
• DC brace per quad function and physician expectations
o Week 8-16:
▪ Rehab/GAP guidelines
• progress plyometric/dynamic balance
• progress comprehensive, lower-extremity stretching program
• progress hip, calf and core strengthening activities
▪ Rehab/GAP Expectations by the end of week 16
• 0 degrees extension without guarding, full knee flexion (heel to buttock)
• Quad 4+/5
• Quadriceps tolerance to endurance activities
o Week 16-24:
▪ GAP guidelines
• begin jogging working to eliminate asymmetries in limb velocity
• continue plyometric progression
• progress sports specific training
▪ GAP Expectation by the end of week 24
• return to sport