PCL and ACL/PCL Reconstruction Protocol
Phase I: Acute
Goals:
- Alleviate acute pain and swelling
- Passive ROM to tolerance(emphasize 0° extension)
- Increase hamstring and quadriceps strength
- Promote comfortable ambulation WBAT with brace and crutches
- Maintain cardiovascular conditioning
Plan: (0-1 week)
- Weight bearing as tolerated with crutches
- Brace locked in full extension all times, No ROM
- Quad sets
- Patellar mobilization
- Ankle pumps
- SLR
- Hip Ab/Adduction
- Calf press with theraband progressing to standing toe raises with full knee extension
- Hamstring and calf stretching
- Standing hip extension
- Modalities for pain and edema control
Plan: (1-4 weeks)
- Weight bearing as tolerated with crutches
- ROM passive only to tolerance(**Maintain anterior pressure on proximal tibia as knee is flexed – prevent posterior sagging at all times**)
- Quad sets
- Patellar mobilization
- Ankle pumps
- SLR
- Hip Ab/Adduction
- Calf press with theraband progressing to standing toe raises with full knee extension
- Hamstring and calf stretching
- Standing hip extension
- Modalities for pain and edema control
Phase II (4-12 weeks)
Goals:
- Decrease swelling and prevent atrophy
- Increase hip strength
- Stimulate collagen healing
- Independent ambulation without crutches
- Continue general conditioning
Plan: (4-8 weeks)
- Weight Bearing: As tolerated w/ crutches (gradually discontinue after 6-8 weeks)
- Brace: 4-6 weeks: Unlocked for gait training/exercises only.
- 6-8 weeks: Gradually discontinue
- 8 weeks: Discontinue use
- ROM: Maintain full extension and progressive flexion
- Continue phase I exercises
- Continue patellar mobilization and ROM activities
- Continue hamstring and calf stretching
- Gait training
- Wall slides and Mini-squats
- Resisted hip exercises in standing (**Resistance must be proximal to knee with hip ab/adduction exercises)
Plan: (8-12 weeks)
- Weight Bearing: as tolerated w/ crutches (gradually discontinue after 6-8 weeks)
- Brace: 4-6 weeks: Unlocked for gait training/exercises only.
- 6-8 weeks: Gradually discontinue
- 8 weeks: Discontinue use
- ROM: Maintain full extension and progressive flexion
- Stationary bike with light resistance (to begin) and seat higher than normal
- Closed chain terminal knee extensions
- Stairmaster
- Balance and proprioception activities
- Leg press (limiting knee flexion to 90 )
Phase III (12 weeks to 9 months)
Goals:
- Full ROM
- Continue all goals from Phase II
- Plan: (12 weeks to 9 months)
- Weight bearing Full, without use of crutches and with a normalized gait pattern
- ROM gain full and pain free
- Advance closed chain strengthening
- Progress proprioception and balance activities
- Maintain flexibility
- Begin treadmill walking to jog progression
Phase IV (9 months and beyond)
- Weight bearing Full
- Maintain strength, endurance, and function
- Begin sport-specific functional progression (backward running, cutting, grapevine, etc.) Progress to running
- Initiate a plyometric program
- Rehab modified with concomitantly performed meniscus repair, articular cartilage procedure, or posterolateral corner reconstruction
**TTWB x 6 wks if Meniscus Repair
Please forward a progress report via fax or e-mail at least one day prior to the next MD visit or give to the patient to hand deliver.