Multi-Ligament Knee Reconstruction — ACL-MCL Reconstruction

UCLA Department of Orthopaedic Surgery Sports Medicine · Thomas Kremen MD

Weight-Bearing

TDWB wks 0-2; full WB locked brace wks 2-4; full WB brace 0-60 deg wks 4-6; WBAT at 10 days post-op; crutches + brace x6 weeks

Key Restrictions

Brace locked in full extension x4 weeks for ambulation and sleeping; TDWB with two crutches wks 0-2, full WB locked extension wks 2-4, full WB brace 0-60 deg wks 4-6; WBAT at 10 days; no OKC hamstring work x6 weeks; flexion limited to 20-60 deg x10 days then 0-90 deg; hamstring stretches begin at 4 weeks (delayed vs other protocols); brace on only in chaotic situations wks 6-12; brace optional after 12 weeks; functional brace recommended during sports 1-2 years

Timeline & Phases

5 phases: Phase I (0-4 wks, brace locked ext x4 wks, TDWB→FWB locked ext→FWB 0-60 deg, flexion 20-60 deg x10 days then 0-90, AAROM/quad sets/SLR/heel slides/patellar mob, pool once sutures removed, biking/leg press/theraband from wk 6), Phase II (6-8 wks, D/C brace/crutches when full ext + SLR without lag, CKC — wall slides/mini-squats/4-way hip/balance/stationary bike, aquatic gait normalization), Phase III (8 wks-6 months, full ROM, Stairmaster/Nordic Trac, knee ext 90-45 eccentrics, CKC activities, slide board proprioception, pool running/swimming no breaststroke), Phase IV (6-9 months, walk/jog progression/running — requires 70% strength + full ROM + no PF irritation + MD clearance), Phase V (9 months+, cutting/jumping/plyometrics/sport-specific, RTS with physician clearance)

Notes

Combined ACL-MCL reconstruction; brace locked in extension x4 weeks (longer than allograft-only at 1 week and allograft+meniscus at 1 week); WBAT at 10 days noted specifically; flexion restricted 20-60 deg x10 days; hamstring stretches delayed to 4 weeks; no OKC hamstring x6 weeks; PT 2x/wk Phase I (vs 1x/wk for allograft-only); PT 3-9 months; functional brace for sports 1-2 years; Thomas Kremen MD, UCLA Sports Medicine; PatientPop hosted protocol

Surgeon / Author

Thomas Kremen MD