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Knee & Shoulder Doctor

Posterior Cruciate Ligament Reconstruction Rehab Protocol

The purpose of this protocol is to provide the physicians, therapists and other care providers with a guideline of the post-operative rehabilitation course. This rehabilitation protocol has been formulated for PCL reconstruction patients using allograft with secure internal fixation. The PCL rehabilitation protocol has several parameters that should be followed closely. The patient should avoid high knee flexion angles early (places a significant stress on new ligament) and should maintain padding behind the leg just below the knee to avoid a “sag.”

The PCL has different kinematics than the ACL and therefore the following are recommended:

  1. Avoid early isolated hamstring exercises (includes curls, isometrics and stretching)
  2. Flexion is gained with passive contraction (i.e., wall slides) – NO ACTIVE HAMSTRING CONTRACTION
  3. Open chain knee extension exercises are allowed from 90-70 degrees early in the postop recovery process. When adequate strength has been obtained, progressive increase in extension is allowed – usually at 6 weeks post-op (physician directed).

Goals of PCL reconstruction

Diminish inflammation, pain and swelling
Obtain normal knee range of motion
Regain voluntary muscle activation
Obtain normal proprioception, balance and coordination for daily activities
Return to sport

During your postoperative course, it is imperative to be mindful of:

  1. Persistent swelling
  2. Abnormal pain or hypersensitivity
  3. Limited range of motion
  4. Weakness of quadriceps
  5. Avoid active hamstring exercises until sixth week post-op

Return to sport/activity

This is dependent on time and clinical progression. Full return to activity requires good strength, flexibility and endurance. These can be tested with multiple clinical and physical therapy parameters.

 

Phase I (Weeks 1-3)

Goals

  • Diminish knee effusion, pain and inflammation
  • Obtain 0-40 degrees ROM
  • Obtain good quad contraction/VMO control


Strength and Exercises

  • SLR in flexion, abduction, and adduction
  • Quad sets
  • Wall and heel slides
  • Ankle pumps
  • Gentle calf stretch


Weight Bearing

  • WBAT with two crutches – physician directed
  • Continue crutches
  • Wean off crutches when able to ambulate without limp


Modalities

  • Cryotherapy
  • Elevate leg in full extension – with padding behind tibia
  • Electrical stimulation


Brace

  • May remove for exercises
  • Must use when ambulating
  • ROM restricted to 0-40 degrees

 

Phase II (Weeks 3-6)

Goals

  • Obtain 0-110 degrees ROM
    • Weeks 2-4 (0-90 degrees)
    • Weeks 4-6 (0-110 degrees)
  • Progress to FWB by end of week 6
  • Improve quad tone
  • Improve lower extremity muscle strength and endurance
  • Restore proprioception
  • Patellar mobilization


Strength and Exercises

  • Continue SLR in flexion, abduction and adduction.
  • Quad sets
  • Start low flexion squats/wall squats (0-30 degrees)
  • Multi angle isometrics at 70-0 degrees of extension
  • Wall slides


Weight Bearing

  • FWB without crutches if adequate quad control


Modalities

  • Cryotherapy
  • Elevate leg in full extension
  • Electrical stimulation with biofeedback


Brace

  • May remove for exercises
  • Must use when ambulating
  • Brace set to 0-90 degrees until week 4
  • Brace opened to 110 degrees at week 6

 

Phase III (Weeks 6-12)

Goals

  • Obtain 0-130 degrees ROM
  • Improve lower extremity strength, proprioception, balance and control
  • Restore confidence


Strength and Exercises

  • Continue SLR in flexion, abduction amd adduction, add extension
  • Continue phase 2 strengthening exercises
  • Start leg press at 0-60 degrees
  • Start knee extension from 90-0 degrees
  • Start walking program at week 10
  • May start reverse lunges Start stationary bike program


Balance Training

  • Single leg stance and plyometric toss (towards end of phase)
  • Balance board, foam roller board (towards end of phase)
  • Proprioceptive exercises


Modalities

  • Electrical stimulation with biofeedback


Brace

  • Discontinue hinge brace at week 6
  • Measure for custom PCL brace at week 6

 

Phase IV (Weeks 12-16)

Goals

  • Obtain full knee ROM
  • Improve strength and endurance
  • Improve neuromuscular control
  • Start skill training at week 16


Strength and Exercises

  • Continue Phase 3 exercises
  • Progress plyometric drills
  • Start running program at week 16
  • Bike for strength/endurance
  • May start swimming (kicking)


Functional Training

  • Gentle lateral movement exercises (i.e., shuffles)


Balance Training

  • Balance board, foam roller board
  • Focus on single leg exercises towards end of phase
  • Proprioceptive exercises

 

Phase V (Weeks 16-36)

Goals

  • Return to sporting activity between 6 to 9 months (physician directed)
  • Achieve maximum strength and endurance

 

Strength and Exercises

  • Continue advanced training
  • Continue bike program for strength/endurance


Functional and Balance Training

  • Progress running and swimming program
  • Start sports metric program at week 20
  • Start high speed training program
  • Progress neuromuscular training program

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