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Dr. Vonda Wright MD

Orthopedic Surgeon

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Rehab Guidelines following Multiple Ligament Knee Reconstruction

The rehabilitation guidelines are presented in a criterion based progression program. General time frames are given for reference to the average, but individual patients will progress at different rates depending on their age, associated injuries, pre-injury health status, rehab compliance, tissue quality, and injury severity. Specific time frames, restrictions, and precautions may also be given to protect healing tissues and the surgical repair/reconstruction.

General guidelines immediately after surgery:

  • WBAT for PCL and ACL/PCL injuries
  • NWB for combined MCL reconstruction for 3 weeks, then PWB for 3 weeks, then FWB at 6 weeks
  • No active hamstring activity for 8 weeks after PLC (Posterolateral Corner) reconstruction
  • No hamstring strengthening for 16 weeks after PLC (Posterolateral Corner) reconstruction

PHASE 1 (0-2 weeks post-op)

Rehab Goals:

  • Control inflammation and pain
  • Full active extension
  • Achieve quadriceps control

Brace:

  • Locked in extension for ambulation for 4 weeks for ACL/PCL and/or MCL reconstruction, then unlocked for ambulation for 2-4 weeks until normal gait is established
  • Locked in extension for ambulation for 12 weeks for PLC reconstruction
  • May remove for ROM exercises
  • Keep brace locked in extension for SLRs for 6 weeks to prevent posterior sag, may remove when quad control is good enough to prevent extension lag

Weigh Bearing Status:

  • WBAT with crutches for ACL/PCL
  • NWB for 3 weeks, PWB for 3 weeks, then FWB for MCL
  • NWB for 6 weeks, PWB for 6 weeks, then FWB for PLC

Suggested Therapeutic Exercise:

  • SLR in all planes (brace locked in extension)
  • Calf pumps, quad sets
  • E-stim as needed
  • Patellar mobilizations
  • Balancing activities on a stable platform with eyes open and closed

PHASE 2 (2-6 weeks post-op)

Criteria:

  • Good quad sets and SLR with brace
  • No active inflammation
  • Full extension

Rehab Goals:

  • Achieve 90 degrees of flexion
  • Protect graft fixation

Brace and Weight bearing Status:

  • As above in Phase 1

Suggested Therapeutic Exercise:

  • Begin ROM (prone passive knee flexion to 90 degrees with care to avoid posterior tibial sag)
  • Wall slides, then progress to mini squats (0-45 degrees) when quad control is good (AVOID if PLC reconstruction was performed within 8 weeks)
  • Pool walking to restore normal gait pattern
  • Toe raises
  • Gastrocnemius stretches
  • Ankle strengthening with sports tubing (Theraband)

PHASE 3 (6-12 weeks post-op)

Criteria:

  • Knee flexion to 90 degrees
  • No active inflammation
  • Good quadriceps control

Rehab Goals:

  • Achieve full flexion
  • Establish normal gait
  • Progress with strengthening and endurance

Brace and Weight Bearing Status:

  • FWB with brace unlocked, may discontinue brace when normal, may discontinue brace when normal gait is established for ACL/PCL and/or MCL reconstructions
  • PWB with brace locked in extension for PLC reconstruction

Suggested Therapeutic Exercise:

  • Begin active knee flexion at 6 weeks for ACL/PCL and/or MCL an at 8 weeks for PLC reconstruction
  • Begin the following at 6 weeks for ACL/PCL and/or MCL and at 8 weeks for PLC recon.
    • Stationary bike (low resistance, high seat, with NO toe clips – so as to prevent hamstring contraction)
    • Mini-squats to 45 degrees
    • Leg press to 60 degrees
    • Stairmaster
    • Elliipicla trainer
    • Proprioception
      • Mini-tramp standing
      • Unstable platform (BAPS) with eyes open closed
      • Standing ball throwing and catching

PHASE 4 (3-6 months post-op)

Criteria:

  • Full, pain-free ROM
  • No patellofemoral irritation
  • Sufficient strength and proprioception to progress to functional activities
  • Normal gait

Rehab Goals:

  • Improve strength and proprioception
  • Maintain FROM

Suggested Therapeutic Exercise:

    • Progress to flexibility and closed-chain strengthening program
    • Swimming (no breast stroke)
    • Stationary bike (may increase resistance)
    • Box steps (6 and 12 inches)
    • Jogging, straight ahead, may be started around 4-5 months when quad strength is 90% of contralateral side

PHASE 5 (6-9 months post-op)

Criteria:

  • Full, pain-free ORM
  • No effusion
  • Sufficient hamstring and quad strength to progress to agility exercises

Rehab Goals:

  • Return to all recreational and sporting activities by 9 months
  • Maintain full, painless motion
  • Progress with strengthening, agility, and endurance

Suggested Therapeutic Exercise:

  • Progress with closed-chain quadriceps and hamstring strengthening
  • Plyometrics
    • Stair jogging
    • Box jumps (6-12 inches)
  • Proprioception
    • Mini trampoline bouncing
    • Lateral slide board
    • Ball throwing and catching on unstable surface
  • Functional Training
    • Running – figure-of-eight pattern
  • Agility
    • Start at slow speed
    • Shuttle run, lateral slides, carioca cross-overs
    • Plyometrics
    • Stair running
    • Box jumps (1-2 foot heights)
    • At 8 months, may start:
      • Sports specific training (start at 25% speed and increase as tolerated)
      • Incorporate cutting
      • Increase heights for plyometric conditioning

Release to Sports:

  • Usually occurs at 9-12 months post-op
  • Full painless ROM
  • Ne effusion
  • Quadriceps and hamstring strength at 90% of contralateral side
  • No apprehension with all sports specific drills

My Other Surgical Specialties

  • Shoulder Surgery
    • Rotator Cuff Repair
    • Subacromial Decompression (SAD) / Distal Clavicle Resection (DCR)
    • Shoulder Instability
  • Hip Surgery
    • Hip Arthroscopic Surgery
    • Rehab Protocols for Hip Surgery
  • Knee Surgery
    • Meniscus
    • ACL
    • MPFL

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About

Orthopaedic Surgeon, Author, Speaker and "The Mobility Doc," Dr. Vonda Wright is an internationally recognized authority on active aging and sports medicine.

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