Posterior Cruciate Ligament (PCL) Autologous Reconstruction Postoperative Rehabilitation Program
Rehabilitation Process after Posterior Cruciate Ligament Reconstruction: The purpose of this rehabilitation program is to provide clinicians with guidance on the rehabilitation process after posterior cruciate ligament reconstruction. It is not meant to replace the physician in the clinical setting of the patient’s post-operative rehabilitation process, specifically based on their examination findings, individual progress, and/or complications present after surgery. If a clinician needs assistance with a patient’s post-operative progress, they should consult with the appropriate surgeon.
General guidelines
1. Open chain N cord muscle training is prohibited
2. Usually the healing time of the graft and bone takes 12 weeks
3, Be careful not to allow the tibia to flatten backwards (gravity-dependent, muscular action)
4.Usually do not do CPM
5, PCL combined with posterior lateral horn repair or LCL repair follow different postoperative care
6.Hip resistance exercises should be applied above the knee joint for hip abduction and adduction; when the hip joint is flexed resistance can be applied distally
7.Supervised physical therapy is generally required for 3-5 months after surgery.
General level of activities of daily living
Patients may begin the following activities unless otherwise indicated by the surgeon.
1. Bathing/showering with brace removed (wiping prior to stitch removal) – one week post-op
2. Usually the patient can return to driving: 6-8 weeks after surgery
3. Usually start sleeping with the brace removed: 8 weeks after surgery
4. Weight bearing without an assistive device: 8 weeks postoperatively (related to the integrity of the structure repaired by the surgeon). Exceptions are PCL combined with posterior lateral horn (PLC) or LCL repair, as above.
Progression of rehabilitation
Phase I: immediately to 4 weeks postoperatively
Objectives.
1. Protect the healing of bone and soft tissue structures
2. Reduce the effects of braking.
Early protection of joint mobility (prevention of tibial retroversion)
Progressive resistance movement of the quadriceps, hip, and lower leg, with emphasis on limiting patellofemoral joint compression and posterior tibial translation
3. education to have a clear understanding of the limitations and the anticipated rehabilitation process and the need to support the proximal tibia/prevent prolapse
Bracing.
1. 0-1 week: always locked in full extension knee position postoperatively
2. One week postoperatively, unlocking of the brace with the help of the therapist for passive mobility training
3. Passive mobility training techniques are as follows: patient is supine; therapist should maintain anterior pressure on the proximal tibia when the knee is flexed (force on the tibia is posterior to anterior); patient has combined posterior cruciate ligament/anterior cruciate ligament reconstruction and the above techniques are modified to maintain the natural position of the proximal tibia when the knee is flexed; it is important to prevent the tibia from sagging posteriorly at all times.
Weight bearing: crutches for tolerable weight bearing, brace locked in extended knee position
Special considerations: Place a pillow behind the proximal tibia at rest to prevent the tibia from sagging backwards
Therapeutic exercises.
1. Patella pushing
2. Knee press
3. Straight leg raise (SLR)
4.Hip abduction and adduction
5.Ankle pump
6, N cord muscle and calf retraction
7.Calf compression with exercise bandage, progress to standing full knee extension heel lift
8.Standing lower hip extension in neutral position
9, functional electrical stimulation (based on weak quadriceps contraction)
Phase 2: 4w to 12w postoperatively
Criteria for entering the second stage.
1, good quadriceps control (good quadriceps, no lag at SLR)
2, Approximately 60 degrees of knee flexion
3, full knee extension
4. No signs of any active inflammation
Objectives.
1, Increased ROM (especially in flexion)
2, Normal gait
3, Continue to improve quadriceps strength and N cord muscle flexibility
Bracing.
1, 4-6w: walk with locked brace in a controlled environment (i.e. patient can walk with PT or at home with locked brace)
2. 6-8w: Brace locked during all activities
3. 8w: Discard brace and follow surgeon
o Note that if PLC or LCL is repaired, continue to wear the brace until the surgeon says to remove the brace
Weight bearing.
1, 4-8w: weight bearing tolerated by crutches
2, 8w: crutches may be discarded if patient meets the following: no quadriceps lag at SLR; fully extended knee; 90-100 degrees of knee flexion; normal gait (may use a single crutch/crutches until gait normalizes)
3. If PLC or LCL repaired, continue to hold crutches until 12 weeks
Therapeutic Exercises.
1. 4-8w.
Squatting/micro-squatting against the wall (0-45 degrees)
Leg stretches (0-60 degrees)
Four ways of contacting the hip in the standing position, flexion, posterior extension, abduction, adduction (from neutral position, full extension knee)
Walking in the pool (resume normal toe gait in chest-deep water)
2. 8-12w.
Power bike (feet in front of pedals, do not pedal with toes to minimize N-cord activity; seat set slightly above normal)
Closed chain resistance exercises at the end of the extended knee with straps and weight-reducing muscles. Note: Pay attention to the position of the resistance point to minimize tibial displacement
Elliptical trainer
Balance and proprioceptive training
Heel lifts in seated position
Stirrups (0-90 degrees)
Phase 3: 3 to 9 months post-op
Criteria for entering phase 3.
1. Complete, pain-free ROM (note: 5 months post-op, lack of 10-15 degrees of knee flexion is most common)
2, normal gait
3, Good normal quadriceps control
4, No patellofemoral joint pain
5. Clear start of more centripetal closed chain training by the surgeon
Objectives.
1. Restoration of remaining motion deficits that may impede functional progression
2. Functional progression to prevent patellofemoral joint irritation
3. Improve functional strength and train proprioception with closed chain exercises
4. Continue to maintain quadriceps strength and N-cord muscle flexibility
Therapeutic exercises.
1.Continue closed chain exercises
2.Running and walking
3.Jogging in the pool with an undershirt or band
4.Swimming (without breaststroke or “frog kick”)
Phase 4: 10th month after surgery, until full return to activity
Criteria for entering the fourth stage.
1. Return to full or progressive/partial activity (i.e., return to work, recreation or athletic activity) as determined by the surgeon
2. No significant patellofemoral or soft tissue inflammation
3. Presence of the necessary joint mobility, muscle strength and endurance, proprioception to safely return to competitive participation in.
Complete pain-free mobility.
Satisfactory clinical examination.
quadriceps having 85% of the strength of the healthy leg.
functional tests having 85% of the healthy leg.
No changes in relaxation tests.
Objectives.
1. safe and progressive return to work or participation in sports
May involve sport specific training, work intensity, or work needs
Patients have a good understanding of the limitations they may be subject to
2. Maintain strength, endurance, and function
Therapeutic exercise.
1. continued closed chain exercises
2. Sport-specific functional progressions, which may include but are not limited to: skateboarding; jogging/running; figure 8 running, backward running, braking; jumping (super isometric movements).