Knee
3 protocols · 5 documents
Clinical Protocols
Free
ACL Reconstruction: Protocol + Exercise Library
Criteria-based guidance with open- and closed-kinetic-chain progression
Most of us were taught that open kinetic chain knee extension is
dangerous after ACLR. This protocol takes the position that the useful clinical questions
are which range, what load, which graft and donor site, what dosage, and how the knee
responded over 24 hours — and it cites the evidence it's reading. Progression runs on
graft type, effusion, objective quadriceps testing, and movement quality rather than
calendar weeks. The companion library maps every exercise to the earliest phase it's
commonly appropriate.
What's inside
- Graft-informed loading notes: BPTB, quadriceps tendon, hamstring, allograft
- OKC progression table with an explicit progression signal at each stage
- Return-to-gym windows with required safeguards at each step
- Effusion rule and traffic-light response system for dosing decisions
- Running-entry and return-to-sport criteria, including psychological readiness
- Dedicated OKC, CKC, proprioception, valgus-correction, and conditioning libraries
Clinical Protocols
Free
MPFL Reconstruction: Protocol + Exercise Library
Criteria-based guidance after medial patellofemoral ligament reconstruction
The single question that changes everything after MPFL
reconstruction is whether it was isolated or combined with tibial tubercle osteotomy,
trochleoplasty, or a cartilage procedure — and that answer lives in the operative report,
not the referral. This protocol is built around that distinction. It restores full
extension early, treats open-chain knee extension as one component of quadriceps recovery
rather than the organizing debate, and sets explicit patellar boundaries: no aggressive
medial mobilization, no lateral stress, nothing that reproduces apprehension. The
companion library assigns every exercise the earliest window it's commonly appropriate —
a floor, not a deadline.
What's inside
- Operative-report checklist: graft, fixation, and the procedures that change the timeline
- Pathway modifiers for isolated MPFLR, MPFLR + TTO, cartilage work, and revision instability
- Patellar mobilization boundaries and apprehension rules stated as hard limits
- Traffic-light 24-hour response system with dosage bands for each training target
- Running-entry and return-to-sport criteria including quadriceps index and hop battery
- Dedicated quadriceps/OKC, CKC, proprioception, and dynamic-alignment libraries
Clinical Protocols
Free
Total Knee Replacement Rehabilitation Protocol
Criteria-based guidance for primary total knee arthroplasty (TKA)
Five phases from preoperative readiness through return to
participation, built around extension priority, quadriceps activation, and symptom-guided
flexion rather than forced stretching. Includes the barriers that actually derail TKA
rehab — extension deficit, flexion plateau, quadriceps inhibition, persistent antalgic
gait — and a specific clinical response for each.
What's inside
- Phase-by-phase progression criteria, with explicit hold-and-communicate triggers
- Urgent escalation table: PE, DVT, infection, and neurovascular red flags
- Progressive loading menu with a stated progression signal for each capacity
- Device-weaning criteria based on gait quality rather than convenience
- Documentation and surgeon-communication checklist, triaged by urgency
Shoulder
2 protocols
Clinical Protocols
Free
Rotator Cuff Repair Rehabilitation Protocol
Criteria-based guidance after arthroscopic or open rotator cuff repair
The label "rotator cuff repair" tells you almost nothing about how
to progress someone. This protocol starts from the operative findings instead — tear
pattern, thickness, retraction, tissue and muscle quality, fixation security — and sorts
patients into lower, moderate, and higher risk pathways from there. It also states plainly
that pain reduction is not evidence of biological healing, which is the assumption behind
most premature loading.
What's inside
- Repair-risk stratification table: what to read from the operative report and why it matters
- Five specific questions to ask the surgeon when the report is incomplete
- Staged PROM → AAROM → AROM with the early-motion trade-off made explicit
- Common barriers: shoulder hiking, good PROM with limited AROM, persistent night pain
- Return-to-participation guidance for driving, work, overhead sport, and manual labor
Clinical Protocols
Free
Reverse Total Shoulder Replacement Rehabilitation Protocol
Criteria-based guidance for reverse total shoulder arthroplasty (rTSA)
A reverse prosthesis behaves differently from an anatomic shoulder,
and generic shoulder timelines don't transfer. This protocol is organized around the
characteristic rTSA instability position, deltoid-dependent function, and the surgical
variables — subscapularis repair, tuberosity healing, tendon transfer — that legitimately
change the timeline. Includes acromial and scapular-spine stress fracture as a named
escalation trigger.
What's inside
- Surgical factor table mapping each variable to its rehabilitation implication
- Instability-position precautions: combined extension, adduction, and internal rotation
- Staged PROM → AAROM → AROM with sling-weaning criteria
- Deltoid and periscapular loading progression, with acromial overload signals
- Realistic motion expectations — functional elevation over native-shoulder ROM
How these were built
Each protocol is an original clinical synthesis, not a copy of any single institution's
pathway. Each one names the source families it draws from — academic rehabilitation
programs, APTA and Academy of Orthopaedic Physical Therapy guidance, JOSPT clinical
practice guidelines, and contemporary enhanced-recovery principles — and states plainly
where institutional protocols disagree with each other. Where a position rests on
specific evidence, that evidence is cited by name rather than asserted.
Timing is described as approximate throughout. The operative report and direct surgeon
instructions take precedence over anything in these documents, and every protocol says so
explicitly. More on how content here gets made →