The RIET Protocol (Standardizing the Knee Rehabilitation Process)

Knee rehabilitation centers across the United States are comfortable achieving a 50% success rate with their knee patient’s recovery.

That might be because 50% is the industry wide common (and expected) outcome.

Recovery therapist and director of clinical operations, Scott Johnson, and Orthopedic surgeon, Dr. Matt Lawless, MD, believe that simply isn’t good enough. Nobody should be satisfied with results similar to that of a coin toss.

Scott Johnson and Dr. Lawless have perfected a process that shatters typical knee surgery results. They have tested and perfected a process proven to achieve higher returns of knee function and knee flexion, while significantly reducing permanent limping.

The gap between the industry success rate and the success rate Johnson and Lawless are achieving has called for a complete overhaul of outdated practices.

Introducing…the RIET (Rest, Ice, Elevation, Therapy) Protocol.

Step 1: Rest (RIET Protocol)

  • Avoid operative leg in dependent position (sitting, standing, walking) for extended periods of time
  • Limit ambulation to short, household distances
  • Avoid sitting with surgical leg dependent

Throughout recovery the main focus is to control edema and regain range of motion.

These principles are especially critical during the initial phase of recovery when the knee is recovering from the planned trauma of surgery.

Step 2: Ice (RIET Protocol)

  • Apply ice to knee with appropriate skin barrier – time and frequency will depend on how the ice is applied
    • (Cooling machine vs. Ice)

Initially, the activity of the patients is limited to minimize the time spent with the surgical leg in a dependent position.

After the initial phase of recovery the body should be able to handle increased activity and tolerate the surgical leg being in a dependent position (standing, sitting, walking) more often. 

Step 3: Elevation (RIET Protocol)

  • Place leg on LRU pillow in the recovery room
  • Place leg on LRU pillow as often as comfortably tolerated, taking breaks as needed

Once the patient is responding without excessive swelling and demonstrates adequate knee ROM, physical therapy can progress into strengthening and further issues of gait quality.

Ultimately, the final phase of rehabilitation is to incorporate high level balance, proprioception, and functional strengthening. 

Step 4: Therapy (RIET Protocol)

  • Therapy begins day of surgery and continues through hospital discharge.
  • Early and continued participation in therapy is required.

The time frames can vary as each patient will react and recover at different rates.

Ultimately, the patient’s response with swelling will guide progression through the protocol. 

Attention Healthcare Professionals!

Discover How You Can Start Using The RIET Protocol In Your Facility