POSTERIOR CRUCIATE LIGAMENT (PCL) REPAIR

WITH POSTERIOR MEDIAL/LATERAL REPAIR

PROXIMAL PCL REPAIR WITHOUT RECONSTRUCTION

REHABILITATION PROGRAM

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.

　

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