Posterior Cruciate Ligament (PCL) Reconstruction Rehab Protocol

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Phase 1 (0-6 weeks)

  • Goals: Control swelling, restore neuromuscular communication loops, prevent kinesiophobia; gait training
  • Modalities: Compressive cyrotherapy, e-stimulation
  • Weightbearing: Non-weightbearing
  • Brace:
    • Locked in full extension at all times for initial 48 hours (2 days).
    • ROM opened 0-90° from day-2 through 4 weeks
    • ROM opened to full, 0-120° weeks 4-6.
  • ROM:
    • First priority is to focus on regaining terminal extension.
    • Advance knee flexion ROM 5-10° daily as tolerated with goal of 90° within 2-3 weeks.
  • Exercises:
    • 0-2wks: Quad sets, SLR, calf pumps, passive leg hangs to 90° at home
    • 2-6wks: PROM/AAROM to tolerance, patella and tibiofibular joint mobs, quad, hamstring, and glute sets, SLR, side-lying hip and core

Phase 2 (6-8 weeks)

  • Weightbearing: Advance 25% weekly until full weightbearing. Instruct patient to recognize maladaptive gait.
  • Brace: Begin to wean from brace after 6 weeks. Advocate to continue in uncontrolled settings or adverse weather.
  • ROM: Full
  • Exercises: Advance phase 1 exercises. Progress weightbearing flexibility, begin toe raises and closed chain quad work. Begin floor-based core and gluteal work, balance exercises, hamstring curls and stationary bike.

Phase 3 (12-16wks)

  • Weightbearing: Full
  • Brace: None
  • ROM: Full
  • Exercises: Progress closed chain activities. Progress proprioception activities. Begin stairmaster, elliptical and running straight ahead at 12wks.
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Phase 4 (16-24wks)

  • Weightbearing: Full
  • Brace: None
  • ROM: Full
  • Exercises: 16wks: Begin jumping; 20wks: Advance to sprinting, backward running, cutting/pivoting/changing direction, intiate plyometric program and sport-specific drills

Phase 5 (>6mo)

  • Weightbearing: Full
  • Brace: None
  • ROM: Full and painfree
  • Exercises: Gradual return to sports participation after completion of FSA***. Maintenance program based on FSA.

*Modified with concomitantly performed meniscus repair/transplantation or articular cartilage procedure ***Completion of FSA (Functional Sports Assessment) not mandatory, but recommended at 22-24wks PO or competitive athletes returning to play after rehab.