MCL PT Protocol

POST-OP DAYS 1 —14

• Dressing:
  • POD 1: Debulk dressing, TED Hose in place
  • POD 2: Change dressing, keep wound covered, continue TED Hose
  • POD 7-10: Sutures out, D/C TED Hose when effusion resolved
• Brace x 8 weeks — Locked in extension for ambulation
• Crutches — Partial weight bearing (PWB) in brace (no more than 50% of body weight)
• Patellar mobilization (teach patient)
• Calf pumping
• AAROM, AROM 0-90 degrees
• Passive extension with heel on bolster or prone hangs
• Electrical stimulation in full extension with quad sets and SLR
• Quad sets, Co-contractions quads/hams
• Straight leg raise (SLR) x 3 on mat in brace — No ADD
• Short arc quads
• No stationary bike x 6 weeks
• Ice pack with knee in full extension after exercise

GOALS

• Pain/effusion control
• Good quad control

Weeks 2 - 4

• Brace x 8 weeks — Open to 0-45 degrees
• Crutches — PWB in brace
• Continue appropriate previous exercises
• Scar massage when incision healed
• AAROM, AROM 0-90 degrees only
• Total Gym for ROM (level 1-3)
  • Passive flexion to 90 degrees (push up with opposite leg)
• SLR x 3 on mat, no brace if good quad control — No ADD
• Double leg heel raises
• No stationary bike x 6 weeks
• Stretches — Hamstring, Hip Flexors, ITB

GOALS

• ROM 0-90 degrees
• No extensor lag

WEEKS 4 - 6

• Brace x 8 weeks — Open to 0-90 degrees
• Crutches — PWB in brace
• Continue appropriate previous exercises
• AAROM, AROM 0-120 degrees
• Standing SLR x 3 with light Theraband bilaterally
  • May begin Hip ADD with Theraband if good LE control in full extension
• Total Gym (level 3-5)— Mini squats 0-45 degrees
  • Passive flexion to 90 degrees (push up with opposite leg)
• Leg press 0-45 degrees with resistance up to V4 body weight
• Hamstring curls 0-45 degrees — Carpet drags or rolling stool (closed chain)
• No stationary bike x 6 weeks

GOALS

• ROM 0-120 degrees
• No effusion

WEEKS 6 - 8

• Brace — Open to full range
• Crutches — Weight bearing as toterated(WBAT), D/C crutch when gait is normal
• Continue appropriate previous exercises
• PROM, AAROM, AROM to regain full motion
• Standing SLR x 4 with light Theraband bilaterally
• Wall squats 0-45 degrees
• Leg press 0-60 degrees with resistance up to 1/2 body weight
• Hamstring curls through full range — Carpet drags or rolling stool
• Forward, lateral and retro step downs in parallel bars
  • No knee flexion past 45 degrees (small step)
• Proprioceptive training
  • Single leg standing in parallel bars
  • Double leg BAPS for weight shift
• Single leg heel raises
• Treadmill — Forwards and backwards walking
• Stationary !Ace — Progressive resistance and time
• Elliptical trainer

GOAL

• Full ROM

WEEKS 8 - 12

• D/C Brace
• Continue appropriate previous exercises with progressive resistance
• Leg press 0-90 degrees with resistance as tolerated
• Hamstring curls on weight machine
• Knee eqnsion weight machine
• Forward, lateral and retro step downs (medium to large step)
• Proprioceptive training — Single leg BAPS, ball toss and body blade, Grid exercises
• Treadmill — Walking progression program
• Stairmaster — Small steps
• Pool therapy

GOAL

• Walk 2 miles at 15 min/mile pace

MONTHS 3 - 4

• Continue appropriate previous exercises
• Fitter
• Slide board
• Functional activities — Figure 8s, gentle loops, large zigzags
• Treadmill — Running progression program
• Pool therapy — Swimming laps
• Quad stretches

GOAL

• Run 2 miles at easy pace

MONTHS 4 - 6

• Continue appropriate previous exercises
• Agility drills / Plyometrics
• Sit-up progression
• Running progression to track
• Transition to home / gym program

GOAL

• Return to all activities

*NO CONTACT SPORTS UNTIL 6 MONTHS POST-OP*