Bone-Patellar-Bone Tendon Rehabilitation

Exercise Introduction

This part of the rehab is only for ACL reconstructions that have been performed with the Bone-Patellar Tendon-Bone graft (B-PT-B graft).  This graft involves taking a small piece of bone from your patella(knee cap), the middle 1 centimeter of the your patellar tendon, and a small piece of bone from your tibia.

After harvesting the graft, the edges of the remaining patellar tendon are typically brought back together with sutures, repairing the defect. This, however, causes the tendon to be thinner than it was initially. Fortunately, by doing exercises you can cause the tendon to regrow to resume its original form.

The exercises to help facilitate the healing of the harvested tendon involve strengthening the leg muscles. Initially, the exercises are performed with 30-50 repetitions as it seems this is the best range to help stimulate growth of the harvested tendon.

The exercises initially will be felt at the graft sight in the front of the knee, just below your patella. After doing the exercises for a few weeks, you will notice that the exercises will begin to be felt in the quadriceps muscles(thigh muscles). That’s your cue that the tendon is healing nicely and the amount of reps can then be backed off to 10.

If the graft was harvested from the same side as your ACL reconstruction, the time to begin these high rep strengthening exercises is once your knee can easily bend to about 125 degrees – about the level of when the heel of your operative side can bend almost to the mid-thigh of the extended opposite leg.

The reason for waiting to begin the strengthening exercises is that working on strengthening the same time you are working on range of motion greatly limits  the gains that you can get in your knee motion.

Initially, it is the range of motion that is most important, so focus on the motion until achieving about 125 degrees of flexion (assuming you have already easily obtained full extension). Then, begin initiating the strengthening.

While you are waiting to get your range of motion back, continue working on quad control exercises (quad sets and straight leg raises) as these won’t affect the motion gains. If the graft was taken from your opposite leg, then your range of motion should be full by a few days and the strengthening can begin.

Single leg squats

Stand close to a firm surface, such as a counter top. Stand on affected foot and lower the body by bending your knee as far as you’re comfortable and return to starting position. As you get stronger, go further and further down. Perform 30-50 reps.

Step Downs

Stand with your affected foot on a step and the non-affected leg off the side of the step with a hand gripped onto something, such as a banister or counter, close by. Lower your body by bending your affected knee as low as possible and return to standing position. Lower as far as you can, going further and further down as you get stronger. Perform 30-50 reps.

Back to ACL Reconstruction Basic/Inital Motion Exercises