General considerations:

•    Patients are weight bearing as tolerated with crutch use as needed post-operatively
•    Range of motion will be blocked from 0-20 degrees in a brace for ADL's and all
     exercises for 4 weeks
•    Important not to push for extension past 0 degrees for 6-8 weeks post-op to protect
     capsular repair
•    No resisted knee flexion exercises for 6-8 weeks post-op
•    Regular manual and self-mobilization of the patella, patella tendon, and portals
     should be performed to prevent fibrosis
•    Return to sport and activities are dependant upon passing a functional, sports test
 

Week 1:

•    M.D., office visit day 1 for dressing change, review of medications and instruction on
     a home 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. General stretching program
•    Well-leg stationary cycling and UBE. Upper body weight machines and trunk
     exercises
 

Weeks 2-4:

•    Progress weight bearing and functional mobility as able to demonstrate good
     mechanics
•    Passive extension stretching to 0 degrees only to protect the capsular repair.
•    Submaximal quad, glute and abduction/adduction isometrics within the range
     restrictions
•    Knee bends (0-20 degrees), calf raises, weight shifting, ankle exs., balance and
     proprioception exercises
•    Patella, suprapatellar pouch and scar mobilization regularly.
•    Short range stair machines as able. Pool walking and workouts as soon as incisions
     are well-healed
 

Weeks 4-6:

•    Brace from 0-70 degrees for day-to-day activities and exercises
•    Submaximal quad and knee extension isometrics through multiple ranges
•    Prone hip extension exercises in extension only
•    Light resistance leg press within range restrictions, abduction/adduction, and hip
     machines at the gym
•    Increase depth of weight shifting, knee bends, step-ups and proprioceptive exercises
     within range. -Initiate two-legged bicycling for range of motion only and without
     resistance


Weeks 6-8:

•    Increase range of motion to full in the brace and wean off when range of motion is
     0-120 deg
•    Introduce hamstring curls against gravity without resistance. Focus on eccentrics
•    Continue to increase intensity and resistance of other exercises
•    Goals are to increase passive and functional range of motion
 

Weeks 8-12:

•    Continue with all exercises
•    Add lateral exercises (i.e. lateral stepping, lateral step-ups, etc.)
•    Begin hamstring flexion exercises against light resistance (i.e. open-chain, hamstring
     curls)
•    Continue all exercises with emphasis on closed-chain, functional and proprioceptive
     program
•    Fit for functional PCL brace. To be used with sporting activities and more ballistic
     rehab exercises
•    Increase resistance of cycling, stair machine, and pool programs
 

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