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