Posterior Cruciate Ligament (PCL) Reconstruction Rehabilitation Protocol 

General Considerations:
• Patients are weight bearing as tolerated with crutch use as needed post-operatively.
• Patients will use a hinged neoprene brace for 4 weeks post-op. It is to be used when up and moving around and is not needed for controlled exercises or sleeping.
• Early emphasis should be placed on achieving full passive terminal extension equal to the opposite side.
• Regular manual and self-mobilization of the patella, patella tendon, and portals should be performed to prevent fibrosis.
• All times should be considered approximate with actual progression based upon clinical presentation.

Week 1:
• Patients are seen post-op Day 1 for dressing change, review of medications, and instruction on a home exercise program.
• Gait training, pain and edema control, and muscle stimulation to improve quadriceps recruitment.
• Ankle pumps, quad and adduction sets, leg raises in multiple planes (except hip extension), mild isometric-resisted knee extension (between 0 - 60°).
• Well-leg stationary cycling and UBE for cardiovascular. Upper body weight machines and trunk exercises.

Weeks 2 - 4:
• Progress weight bearing and functional mobility as able.
• Passive flexion and extension stretching. Push for full hyperextension within this time.
• Submaximal quad, knee extension, and adduction isometrics in multiple ranges.
• Short range (0 - 60°) squats/knee bends, calf exercises, standing hip exercises.
• Balance and proprioception exercises.
• Weight machines consisting of light weight and high repetitions. Leg press, calf raises, hip machines and abduction/adduction.
• Patella, patella tendon, and scar mobilization regularly.
• Progress to two-legged cycling without toe straps and short-range stair machines as able. Swimming and pool workouts as soon as incisions are well-healed.

Weeks 4 - 6:
• Wean off the use of the brace for activities of daily living.
• Prone hip extension exercises performed in full knee extension only.
• Gradually increase the depth of knee bends, step exercises, and proprioception exercises.
• Add toe straps and gradual resistance with stationary bike.

Weeks 6 - 8:
• Introduce hamstring curls against gravity without resistance. Focus on eccentrics.
• Continue to increase the intensity and resistance of other exercises.
• Passive range of motion should be near normal.

Weeks 8 - 12:
• Add lateral training exercises (i.e. lateral stepping, lateral step-ups).
• Begin hamstring flexion exercises against light resistance (i.e. open-chain, hamstring curls).
• Fit for functional PCL brace to be used for sporting activities and more ballistic rehabilitation training.

Weeks 12 - 16:
• Goals are to increase strength, power, and cardiovascular conditioning.
• Sport-specific exercises and training program.
• Maximal eccentric-focused strengthening program.
• Begin light running program as able to demonstrate good strength and mechanics.

Months 4 - 6:
• Goals are to develop maximal strength and power, and to advance to sporting activities.
• Resisted closed-chain rehabilitation through multiple ranges.
• Running program, balance drills, and agility program.
• Initiate plyometric training as able to demonstrate adequate strength and proper mechanics. 

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.