PCL Reconstruction

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

Toe-touch WB in locked brace at 0 deg Phase I (brace worn 3 wks locked in extension for ambulating/sleeping); TWB to 75% WB with crutches Phase II, brace remains locked at 0; crutches discontinued Phase III when gait non-antalgic

Key Restrictions

No active extension allowed Phase I; ROM performed prone; open chain knee extension exercises and isokinetic strengthening never performed throughout protocol

Timeline & Phases

Phase I (0-3 wks): TTWB in locked brace at 0 deg (worn 3 wks for ambulation/sleeping), reduce swelling with cryocuff, no active extension allowed, ROM performed prone (passive flexion 0-70 deg, active-assisted extension 70-0 deg), toe touch WB with two crutches, patellar mobilization 5-10 min/day x6 months, prone hangs for symmetric extension, towel extensions, isometric quad sets at 0/60 deg flexion (3x10, 10 sec hold, 3x/day), SLR in locked post-op brace (3x10, 3x/day), UE ergometer/core strengthening; progress to Phase II after 3 wks if pain well-controlled; Phase II (3-6 wks): TWB to 75% WB with crutches, brace remains locked at 0, prone ROM (passive flexion 0-90 deg, active-assisted extension 90-0 deg), short crank (90mm) ergometry, 0-60 deg arc leg presses, SLRs all planes with progressive resistance, multi-angle quad isometrics 20-60 deg, UE ergometry/core strengthening; progress to Phase III after 3 wks if pain well-controlled and progressive quad control; Phase III (12-20 wks): discontinue crutches when gait non-antalgic, dual-to-single limb control, advance to standard ergometry once ROM reaches 115 deg, AAROM advancing at 12 wks to quad stretching/proprioception (perturbations), forward step-up program, leg presses/mini-squats 0-60 deg advancing to 0-80 deg at 12 wks, step-down program at 8 wks, BAPS/prop board/lunges/Versaclimber/agility (sport cord)/retrograde treadmill at 12 wks, Stairmaster/Aquacisor/retrograde treadmill cardio; progress to Phase IV with pain-free minimal swelling, independent non-antalgic gait, functional hop test >85% contralateral, satisfactory 8in step descend; Phase IV (20+ wks): begin forward running program, initiate agility drills and cutting activities, continue LE strengthening/flexibility/proprioceptive/agility programs, floor beam if applicable, initiate plyometric program, advance agility/sport-specific programming, maintenance exercise program

Notes

OSMS Rehabilitation Guidelines; emphasizes early restoration of symmetric knee ROM while protecting the graft; open chain knee extension and isokinetic strengthening never performed (contrasts with OSMS's ACL protocol which restricts these only until wk 8); references Petrigliano & McAllister (2006), Peccin et al., Shelbourne et al. (1999), and Chhabra/Kline/Harner (2006) on PCL injury/reconstruction