Posterolateral Corner Reconstruction Rehabilitation Protocol

General Considerations:
-Full weightbearing as tolerated with hinged brace locked in full extension for 4 weeks.
-Patient will be instructed to come out of the brace twice a day for gentle, passive stretching into flexion. Avoid active knee flexion for 4 weeks.
-Regular assessment of gait to watch for compensatory patterns. Watch especially to avoid posterior-lateral knee thrust in stance phase of gait.
-Regular manual treatment to soft tissue and incisions to decrease the incidence of fibrosis.
-No resisted leg extension machines (isotonic or isokinetic) at any point in the rehab process.
-No high impact or cutting/twisting activities for at least 3 - 4 months post-op.
-MD follow-up visits at Day 1, Day 8 - 10, 1 month, 4 months, 6 months, and 1 year post-op.

Week 1:
-MD visit Day 1 post-op to change dressing and review home program.
-Icing and elevation regularly.
-Straight leg raise exercises (lying, seated, and standing), quadricep/adduction/gluteal sets/abduction exercises.
-Hip and foot/ankle exercises, well-leg stationary cycling, upper body conditioning.
-Pool/deep water workouts after the first 8 - 10 days (once incisions are healed) and with the use of a brace locked in full extension.
-Soft tissue treatments for edema/pain control and to patella and incisions.

Weeks 2 - 4:
-MD visit at 10 - 14 days for suture removal and check-up.
-Manual resisted (i.e. PNF patterns) of the foot, ankle, and hip. Trunk and gluteal stabilization program.
-Continue with pain control, range of motion, soft tissue treatments, and proprioception exercises.
-Non-weightbearing aerobic exercises (i.e. unilateral cycling, UBE, Schwinn Air-Dyne non-involved limb and arms only, pool workouts).

Weeks 4 - 6:
-MD visit at 4 weeks post-op; will wean off use of rehab brace. Brace ROM can be set at open during wean off process.
-Stretching and manual treatments to work on full range of motion into flexion and extension.
-Incorporate functional exercises (i.e. knee bends/squats, calf raises, step-ups, proprioception).
-Stationary bike and progressing to road cycling as tolerated.
-Slow walking on treadmill for gait (preferably a low-impact treadmill).

Weeks 6 - 8:
-Increase the intensity of functional exercises (i.e. cautiously increase depth of closed-chain exercises, Shuttle/leg press). Do not overload closed- or open-chain exercises.
-Add lateral training exercises (i.e. side-step-ups, lateral stepping) once adequate mechanics are achieved.
-Patients should be progressing to walking without a limp and range of motion should be at least 80%.

Weeks 8 - 12:
-Introduce more progressive single-leg exercise (i.e. Theraband leg press, single-leg calf raises).
-Careful analysis of gait and mechanics with corrective treatment (i.e. orthotics, glute strengthening).
-Patients should be pursuing a home program with emphasis on sport/activity-specific training.

Weeks 12 - 16:
-Low-impact activities until able to demonstrate adequate completion of a functional/sport test.
-Increasing intensity of strength, power, and functional training for gradual return to activities.

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.