Multi-Ligament Knee Reconstruction — ACL and Posterolateral Corner (PLC) Reconstruction

UCLA Department of Orthopaedic Surgery Sports Medicine · Thomas Kremen MD

Weight-Bearing

NWB x3 weeks; full WB with crutches/locked brace at wk 3; full WB without assistive devices at 8 weeks (with MD clearance)

Key Restrictions

Brace locked at 20 deg wk 1, 10 deg wk 2, 0 deg wk 3; PROM by PT with brace on at 3-8 days post-op; ROM graduated: 20-60 deg wk 1, 10-70 deg wk 2, 0-80 deg wk 3, 0-90 deg wk 4; NWB x3 weeks; full WB with crutches/locked brace at wk 3; WBAT with crutches wks 4-8; full WB without assistive devices at 8 weeks with MD clearance; no OKC hamstring work; sleep without brace permitted at 8 weeks; caution against posterior tibial translation (gravity and muscle action); pillow under proximal posterior tibia at rest to prevent posterior sag; hip resistance placed above knee for AB/AD PREs; driving at 6 weeks; no breaststroke swimming; CPM used

Timeline & Phases

4 phases: Phase I (0-4 wks, NWB x3 wks, brace locked 20→10→0 deg progressively, ROM increasing to 0-90 deg by wk 4, quad sets/SLR/hip AB-AD/ankle pumps, PROM with PT starting 3-8 days post-op; pillow under proximal tibia at rest; FES if poor quad contraction), Phase II (4-12 wks, WBAT crutches wks 4-8, brace unlocked for gait training only wks 4-6 then all activities wks 6-8, D/C crutches wks 8-12 when quad control + full ext + flex 90-100 + normal gait, OKC extension when independent quad control, wall slides/mini-squats/4-way hip, pool gait, stationary bike from wks 8-12, Stairmaster/balance/leg press ≤90 deg), Phase III (3-9 months, full pain-free ROM, CKC progression, treadmill/pool jogging/swimming no breaststroke), Phase IV (9-12 months, RTS — MD clearance + sports-specific training, slide board/jog-run/cutting/plyometrics/work hardening)

Notes

ACL + PLC multi-ligament reconstruction — most restrictive WB in this UCLA series: NWB x3 weeks; brace ROM graduated weekly rather than locked in full extension; caution against posterior tibial translation is PLC-specific concern; pillow under proximal tibia at rest to prevent posterior sag; no OKC hamstring throughout; CPM used (unlike all other Kremen protocols in this series); hip resistance above knee for AB/AD; FES for poor quad contraction Phase I; PT extends to 12 months; RTS at 9-12 months; Thomas Kremen MD, UCLA Sports Medicine; PatientPop hosted protocol

Surgeon / Author

Thomas Kremen MD