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PCL Reconstruction

 

POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION REHABILITATION

 

General considerations:

  • – Patients are touch-down weight bearing with crutches for 4 weeks post-operatively.
  • – Patients will use a hinged neoprene brace for 8 weeks post-op. It will be locked in full extension for 4 weeks and then progressed to 0-30 at 4 weeks and 15 degrees a week until 8 weeks
  • – Early emphasis on achieving full passive terminal extension equal to the opposite side. *No resisted knee flexion exercises for 8 weeks post-op. Passive flexion okay.
  • – Regular manual care of the patella, patella tendon, and portals should be performed to prevent fibrosis
  • – All times are approximate with actual progression based upon clinical presentation.

Week 1:

  • – Gait training, pain and edema control, and muscle stimulation as needed for quadriceps recruitment.
  • – Ankle pumps, quad sets, and leg raises into flexion and abduction only.
  • – Well-leg stationary bike and UBE for cardiovascular. Upper body weight machines and trunk exercises.

Weeks 2-4:

  • – Passive flexion and extension stretching.
  • – Prone hip extension exercises performed in full knee extension only after 2 weeks.
  • – Submaximal quad and gluteal isometrics.
  • – Standing calf and hip exercises
  • – Balance and proprioception exercises
  • – Swimming and pool workouts as soon as incisions are well-healed.

Weeks 4-6:

  • – Introduce mild isometric resisted knee extension within range of motion restrictions.
  • – Short range squats/knee bends within range of motion restrictions.

Weeks 6-8:

  • – Gradually increase the depth of knee bends, step exercises and proprioception exercises
  • – Introduce hamstring curls against gravity without resistance after 7 weeks. Focus on eccentrics.
  • – Continue to increase the intensity and resistance of other exercises.
  • – Passive range of motion should be near normal

Weeks 8-12:

  • – Wean off the use of the brace for activities of daily living.
  • – Begin hamstring flexion exercises against light resistance. Increase as tolerated.
  • – Cautiously add lateral training exercises (i.e. lateral stepping, lateral step ups).

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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