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PCL reconstruction rehab protocol

General considerations

  • Patients are weight bearing as tolerated with crutch use as needed post-operatively.
  • Patients will use a hinged brace LOCKED IN FULL EXTENSION for 4 Weeks post-op. It is to be used when up and moving around and not needed for controlled exercises or sleeping.
  • Early emphasis should be placed on achieving full passive terminal extension equal to the opposite side.

*No resisted knee flexion exercises for 4 Weeks post-op.

  • Regular manual care 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.
  • Passive flexion (bending) once or twice per day to maintain motion.

Week 1

  • M.D./Nurse appointment for dressing change day 2, review of home program.

Manual

  • Effleurage for edema, soft tissue mobilization to surrounding tissues, gentle range of motion.

“No touch zone” 2 inches from incisions/portals x 4 Weeks.

Exercises

  • 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 degrees).
  • Well-leg stationary cycling and UBE for cardiovascular. Upper body weight machines and trunk exercises.

Goals

  • Decrease pain and edema.
  • Gait weight bearing as tolerated with brace locked in full extension x4 Weeks.

Weeks 2 - 4

Manual

  • Continue with effleurage, soft tissue mobilization, patellar glides, range of motion.

Exercises

  • Progress weight bearing and functional mobility as able.
  • Passive flexion and extension stretching. Push for full hyperextension within this time.
  • Prone hip extension exercises performed in full knee extension only.
  • Submaximal quad, knee extension and adduction isometrics in multiple ranges.
  • Short range (0-60 degrees) squats/knee bends, calf exercises, standing hip exercises.
  • Balance and proprioception exercises.
  • Weight machines consisting leg press, calf raises, hip machines and abduction/adduction.
  • Progress to two-legged cycling and short range stair machines as able.

Goals

  • Decrease pain and edema.
  • Progress weight bearing as able with focus on good gait mechanics, brace locked in full extension x 4 Weeks.

Weeks 4 - 6

  • MD appointment at 4 Weeks, wean off the use of the brace.

Manual

  • Continue with soft tissue, joint mobilizations, patellar glides.

Exercises

  • Introduce hamstring curls against gravity without resistance. Focus on eccentrics.
  • Gradually increase the depth of knee bends, step exercises and proprioception exercises.
  • Add toe straps and gradual resistance with stationary bike.
  • Swimming and pool workouts as soon as incisions are well-healed.

Goals

  • Gait full weight bearing, good mechanics with no brace.
  • Range of motion 80% of non-surgical leg.

Weeks 6 - 8

Manual

  • Continue with soft tissue, joint mobilizations, patellar glides to increase range of motion.

Exercises

  • Add lateral training exercises (i.e. lateral stepping, lateral step-ups).
  • Continue to increase the intensity and resistance of other exercises.
  • Passive range of motion should be near normal.

Goals

  • Full range of motion.

Weeks 8 - 12

  • Begin hamstring flexion exercises against light resistance (i.e. open-chain, hamstring curls).
  • Continue to increase functional exercises, endurance, strength, and proprioceptive type exercises.

Goals

  • Initiate sport specific training drills.

Weeks 12 - 16

  • Sports Test 1, initiate return to run program.
  • Goals are to increase strength, power and cardiovascular conditioning.
  • Sport-specific exercises and training program.
  • Maximal eccentric focused strengthening program.
  • Fit for functional PCL brace to be used for sporting activities and more ballistic rehabilitation training.

Goals

  • Pass Sports Test 1.
  • Return to low impact activities, slow progression to higher impact activities. 4-6 months: Goals are to develop maximal strength, power and advance to sporting activities.
  • Resisted closed-chain rehabilitation through multiple ranges.
  • Running program, balance drills and agility program.

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

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