Non-Operative — PCL Rehabilitation

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

WBAT with knee in full extension Phase I (unlock brace once effusion controlled and SLR performed without quad lag); WBAT continues Phase II-III with PCL brace worn at all times for activity

Key Restrictions

Avoid hyperextension x12 wks; prevent posterior tibial translation/limit posterior sag x12 wks; isolated hamstring exercises avoided until wk 12; double leg strengthening limited to <=70 deg knee flexion through wk 12; PCL brace worn at all times if available through Phase III

Timeline & Phases

Phase I (wks 1-6): PRICE (pain/swelling control, compression, elevation, effusion management), avoid hyperextension, prevent posterior tibial translation, avoid isolated hamstring exercises, WBAT with knee in full extension (unlock brace once effusion controlled and SLR without quad lag), prone passive ROM 0-90 deg first 2 wks then progress to full ROM (prone position limits hamstring activation/gravity forces), PCL brace worn at all times, patellar mobilizations, hamstring/gastrocnemius stretching to reduce tibial pull, quad activation/strengthening, SLR once quad can lock terminal extension without lag, gait mechanics training, stationary bike zero resistance once ROM >115 deg, weight shifts for crutch weaning, pool walking to assist crutch weaning, calf raises/single leg balance when weaning crutches, UE/core strengthening; Phase II (wks 6-12): continued avoidance of hyperextension, prevent posterior tibial translation, double leg strengthening limited to <=70 deg knee flexion, WBAT, full supine/prone ROM after wk6, PCL brace at all times, muscular endurance emphasis (3x20 reps), continue PRICE, gastroc/light hamstring stretching, leg press limited 0-70 deg, squat progression (squat to squat-with-calf-raise to squat-with-weight-shift), static lunge, hamstring bridges on ball with knees extended, progressive resistance stationary bike, light pool kicking, incline treadmill walking (5-15% incline), single leg deadlift with knee extended, proprioceptive/balance exercises; Phase III (wks 12-16): continue brace for activity (may remove at rest), progress ROM/strength beyond 70 deg flexion, isolated hamstring exercises may begin after wk12, muscular endurance/strength emphasis, prepare for sport-specific activity, double leg press progressing to single leg, single leg knee bends, balance squats, single leg deadlift, single leg bridges starting wk16, continue bike/treadmill walking, running allowed once sufficient strength/stability demonstrated and quad girth >=90% contralateral

Notes

OSMS Rehabilitation Guidelines; non-operative management for PCL injury; posterior tibial translation/sag prevention and hyperextension avoidance are the central precautions through wk 12