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 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 day 1 out of surgery for dressing change, review of medications
     and instructed 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 degrees)
•    Well-leg stationary cycling and UBE for cardiovascular. Upper body weight machines
     and trunk exs


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 degrees) 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 rehab
     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.


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
•    Initiate plyometric training as able to demonstrate adequate strength and proper
     mechanics