PCL reconstruction rehab protocol
- 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.
- M.D./Nurse appointment for dressing change day 2, review of home program.
- Effleurage for edema, soft tissue mobilization to surrounding tissues, gentle range of motion.
“No touch zone” 2 inches from incisions/portals x 4 Weeks.
- 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.
- Decrease pain and edema.
- Gait weight bearing as tolerated with brace locked in full extension x4 Weeks.
Weeks 2 - 4
- Continue with effleurage, soft tissue mobilization, patellar glides, range of motion.
- 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.
- 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.
- Continue with soft tissue, joint mobilizations, patellar glides.
- 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.
- Gait full weight bearing, good mechanics with no brace.
- Range of motion 80% of non-surgical leg.
Weeks 6 - 8
- Continue with soft tissue, joint mobilizations, patellar glides to increase range of motion.
- 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.
- 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.
- 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.
- 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