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)