Avoid the patellar tendon graft. Modify the rehabilitation program to avoid any concentric-resisted quadriceps exercises. The weight program may have to be eliminated entirely, and the exercise bike, with toe straps, may be the only form of activity tolerated.
Daniel stated that the principal cause of anterior knee pain is the lack of extension. He felt that the flexion contracture led to increased patellofemoral contact force and to the development of chondromala-cia patella. The aggressive rehabilitation program that emphasizes early knee extension may prevent the development of the flexion contracture.
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