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

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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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Episode Transcript

Speaker 1 (00:00):
Hello everyone and welcome to episode 373 of the
World of the Southbound podcast.

Speaker 2 (00:04):
I'm your host, paul Marci, and today we're going to
be talking about what steps andpotential attending and care
progressions from 12 weeks andup.
We're going to discuss ourrehab goals on the stage
activities to avoid at thisstage, exercise recommendations
and progressions to function somuch more.
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Welcome back everyone.
So today we are in part four ofour patella or quad tendon

(01:41):
repair rehab segment, or quadtendon repair rehab segment.
If you didn't listen toepisodes 370 through 372, you
might want to go back and listento those first.
I really didn't think we weregoing to continue on this
subject, but you know, I get anidea in my head.
It gets to rolling and I'm like, okay, we should just take this
right to the end.
So today will be the fourthinstallment of our four part

(02:02):
series on quad tendon, patellatendon repair rehab.
Now here we are.
We are at the 12-week post-opperiod.
At this point patients shouldbe pretty darn close to having
full range of motion in the kneeand should have close to
natural gait on level surfaces,if not good, equal, symmetrical

(02:23):
gait when they're walking on alevel surface.
Here's some precautions we wantto talk about would be like
avoiding lots of impactactivities, especially forceful
eccentric contractions.
Also focus on good symmetrywith movement.
So what about exercise?
Well, it's time to start withsome balance drills, a little
bit of weight shifting.
Here we start with double legwork.
Our time to start with somebalance drills, a little bit of

(02:45):
weight shifting.
Here we start with double legwork, our way to single leg on a
solid surface.
We might go stable to lessstable and then we might start
with the knees in an extendedposition and then work our way
into more of a flexed position.
So, going from that stable toless stable surface, double to
single and knees extended toknees flexed, really starting to

(03:05):
work on that proprioception,okay, and there are many
different ways you can work onbalance.
Just don't start toaggressively.
Get these people kind ofconfident.
They're really rehabbing fromthis particular injury requires
a lot of confidence, okay.
So they don't have too muchkinesiophobia as they're moving
forward.
They can be stationary biking.
They definitely have enoughrange of motion now they can get

(03:26):
onto an elliptical.
It's a little moreweight-bearing.
It gets them bending that leg alittle more naturally.
I like it because it has almostkind of like a walking
simulation.
It keeps you in an uprightposture and gets that cardio up
there a little bit better.
You know, just slowly work onincreasing the resistance on
both of them.
Now, as far as gait drills go, Ilike to work on forward

(03:50):
backward lateral walking.
I like to do resisted lateralwalking almost, you know, really
early with a full kneeextension so you can really
start to develop some glute medstrength.
I'll work into some short steps, shallow steps, and I'll work
into something higher so thatthey're really kind of actively
flexing the knee as they'restepping over.

(04:11):
It might be a hurdle or a coneor something like that.
You really want to work onfunctional movements now walking
functional movements.
From there we can start intosome close kinetic chain quad
exercises.
So you can start mini squatslike a shuttle or a leg press
machine and you know you want toget to being upright vertical
and squatting up to about 70degrees of knee flexion till you

(04:35):
get to about the four monthmark.
Then you can start working onmulti directionaldirectional hip
and core exercises.
Now remember your anatomy here.
Okay, you can do a plank, alateral plank on one side, do a
lateral plank on the other side.
That's not going to affect apatella or quad repair.
But imagine you're doing aprone plank.
Think about that.

(04:56):
We have this really long lever.
The quad is contracting hardand it's in a lot of tension.
There's a lot of tension onthat extensor mechanism.
So think about the anatomy ofthat 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 afoam roll underneath the shins

(05:16):
or maybe even up above the thigha little bit, so they can start
into, you know, a little bit ofcore stability with a plank.
And then you progress with thatfoam roller going further and
further down the shins and thenyou get to the toes without the
foam roller, and then youprogress from there.

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Speaker 2 (06:01):
Once the patient has achieved full range of motion,
they have good gait symmetrythey're able to balance on one
leg for 10 to 15 seconds and cansquat down to about 70 to 80
degrees, then you can progressto a higher you know activity

(06:24):
level around that four monthmark.
So here your goal is going tobe to be able to have your
patient do some sports, specifictype activities or work
specific type activities andcontrol that eccentric load
better.
Okay, so you just start to workon deceleration activities.
So maybe you get them.

(06:45):
You're doing some light joggingat first and then you have them
start and stop.
So you go from forward joggingto retro jogging and you just
teach them how to slow down withmany steps rather than a real
aggressive deceleration.
And then you work on thatchange of direction.
Maybe they start to dorotational activities, they
start to work in diagonals.

(07:05):
I like to get them doing verylittle hopping.
Okay, maybe on a shuttle or alight leg press, something that
is less than body weight, andthen you go from double-legged,
less than body weight, to fullbody weight standing and then
you ultimately go from jumpingon one leg, single leg on the

(07:27):
same side.
So let's say you have a leftquad tendon, you can do a little
single legged hopping and thenyou start to work from hopping
from one leg to another soyou're adding this little
lateral movement with it, so youcan then from there start to
work into your higher levelactivities.
This is where you really haveto be creative.
You know, patients may not becoming into therapy as long, but
they're on a exercise programand then in the clinic you're

(07:49):
just kind of working onprogressions and starting to
build them up so that they feela little bit more confident if
they're going to go back out andplay sports or maybe even go
back to work and, you know, doconstruction or do something
where they do have to do a lotof climbing or squatting and
getting down from the floor andgetting back up.
So now I'm a little moreconservative with these

(08:10):
particular diagnoses of patellartendon rupture and quad rupture
.
I'd rather progress them slowerand steady, maybe have a little
bit of weakness, maybe have alittle bit of tightness, but
have good tissue integrity,rather than push them too hard
too early and end up re-injuringthem, because fixing a

(08:30):
re-rupture is never good and theintegrity is not great.
Knock on wood, I've never seenthis happen before of batting
1,000 on these.
A couple years ago actually wehad three at the same time.
Two of them we had discoveredin our clinic.
On one day they came in withbasically knee contusion and
knee pain.
They both had quad ruptures andwe rehabbed them and they did

(08:53):
very, very well.
So these people generally willdo really well.
Something else I want you totake into consideration If the
person is rehabbing with you andfor some reason maybe they get
sick, they need to take aquinolone antibiotic and for
some reason maybe they get sick,they need to take a quinolone
antibiotic.
Remember, these antibiotics inthis group can put you at high

(09:13):
risk of rupture.
So you really want to slow thatprogram down, especially if
you're working around the quadsa lot.
I would just kind of lightenthat up a little bit while
they're on the medication andjust take a slower approach to
this.
The other thing to take intoconsideration is if your patient
is a smoker or maybe they don'texercise regularly, that tissue

(09:35):
integrity just isn't going tobe as good.
So, like I said, I'm a littlemore conservative with these
folks and then I always try tochat with the surgeon about the
integrity of the tissue before Iget started with them and that
way I know how to progress thema little bit better.
I you know I might feel alittle more confident
progressing them faster if theyhave really good integrity and
they were able to get a goodpurchase.

(09:55):
You know when they put thatpatella tendon back together or
quad sewed back together.
So I hope you enjoyed thisseries of podcasts.
If it's something that you'dlike to see more of, send me an
email or click on the.
Send me a text link in the shownotes and I'll see what I can
do.
If you're listening to thispodcast before May 31st 2025,
and you're interested in myupcoming live shoulder course in

(10:19):
Auburn, maine, go to my website, check out the agenda.
I'll put a link in the shownotes.
You can check out the coursecontent, see what the course
consists of.
If you want to register, by allmeans go ahead and do that.
I'd love to see you there.
Have a great day, folks.
Be kind to each other and takecare.