PCL Reconstruction — / PCL-ACL Combined Reconstruction

UCLA Department of Orthopaedic Surgery - Sports Medicine · Thomas Kremen MD

Weight-Bearing

Toe touch WB with crutches Phase I (0-4 wks); WBAT with crutches wks 4-8; FWB at 8 wks with physician clearance; if PCL+PLC/LCL repair: crutches x 3 months

Key Restrictions

No OKC hamstring work throughout; maintain anterior pressure on proximal tibia during all ROM (neutral position for combined PCL/ACL); pillow under proximal posterior tibia at rest to prevent posterior tibial sag; brace locked at 0° x 1 wk; brace unlocked for controlled gait wks 4-6, all activities wks 6-8; D/C brace at 8 wks (unless PLC/LCL repair); stationary bike foot forward without toe clips; leg press to 90° flexion; swimming no breaststroke; driving 6-8 wks; if PCL+PLC/LCL: crutches x 3 months; 12 wks assumed graft-to-bone healing; flexion may lag 10-15° up to 5 months post-op; PT 3-5 months

Timeline & Phases

Phase I (0-1 month): TTWB brace locked at 0°, pillow under proximal tibia at rest, quad sets/SLR/hip AB-AD/ankle pumps, FES for trace-poor quad, HS/calf stretching, standing calf raises with full extension, standing hip extension | Phase II (1-3 months): WBAT with crutches wks 4-8, brace unlocked for gait wks 4-6 then all activities wks 6-8, D/C crutches at 8 wks when criteria met (no quad lag, full extension, 90-100° flex, normal gait), wall slides 0-45°, 4-way hip, pool ambulation, stationary bike (no toe clips, seat slightly high), CKC TKE, Stairmaster, balance/proprioception, seated calf raises, leg press ≤90° | Phase III (3-9 months): full pain-free ROM, normal gait, good-to-normal quad, CKC progression, treadmill, pool jogging with wet vest, swimming no breaststroke | Phase IV (9+ months): RTS functional progression, slide board, jog/run, figure 8/carioca/backward running, cutting, plyometrics, sport-specific drills

Notes

Single protocol covering PCL-only and combined PCL+ACL reconstruction; assume 12 wks graft-to-bone healing; no OKC hamstring work throughout — critical to prevent posterior tibial translation; PCL patients: maintain anterior pressure on proximal tibia during ROM; combined PCL/ACL: maintain neutral tibial position; if PCL+PLC/LCL repair: crutches x 3 months per general guidelines; driving at 6-8 wks; FWB at 8 wks; flexion may lag 10-15° for up to 5 months post-op; PT 3-5 months supervised; resistance for hip PREs placed above knee for AB/AD; Kremen MD UCLA PatientPop practice site

Surgeon / Author

Thomas Kremen MD