PCL Reconstruction Rehab Protocol

General Considerations

• Patients are weight-bearing as tolerated with crutch use as needed post-operatively.
• Early emphasis should be placed on achieving full passive terminal extension equal to the opposite side
• 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
• Regular manual care of the patella, patella tendon and portals should be performed to prevent fibrosis.
• Passive flexion (bending) once or twice per day to maintain motion.
• All times should be considered approximate with actual progression based upon clinical presentation.

Weeks 1

Dressing change day 2,

Manual

• Effleurage for edema, delicate tissue mobilization to surrounding tissues, gentle range of motion.
• “No touch zone” 2 inches from incisions/portals x 5 Weeks.

Exercises

• Gait training, pain and edema control, and muscle excitement to improve quadriceps recruitment.
• Ankle pumps, quad and adduction sets, leg raises in various planes (except hip extension), mild isometric resisted knee extension (between 0-60 degrees).
• Well-leg stationary cycling and UBE for cardiovascular. Upper body area weight machines and trunk works out.

Goals

• Gait weight bearing as tolerated with brace locked in full extension x5 Weeks.
• Decrease pain and edema.

Weeks 2 – 4

Manual

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

Exercises

• Progress weight bearing and functional mobility as capable.
• Passive flexion and extension stretching. Push for full hyperextension within this time.
• Prone hip extension Works outperformed in full knee extension only.
• Submaximal quad, knee extension, and adduction isometrics in various ranges.
• Short range (0-60 degrees) squats/knee bends, calf f works out, standing hip activities.
• Balance and proprioception work out.
• Weight machines consist of leg presses, calf raises, hip machines, and abduction/adduction.
• Progress to two-legged cycling and short-range stair machines as capable.

Goals

• Progress weight bearing as able with focus on good gait mechanics, brace locked in full extension x 5 Weeks.
• Decrease pain and edema

Weeks 4 – 6

• Visit appointment at 5 Weeks, wean off the use of the brace.

Manual

• Continue with delicate tissue, joint mobilizations, and patellar glides.

Exercises

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

Goals

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

Weeks 6 – 8

Manual

• Continue with soft tissue, joint mobilizations, and patellar glides to increase the 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.
• The 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 a return to run the program.
• The 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, and 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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