Multi-ligament knee reconstruction

Post-op recovery	First 2 weeks	Date
Goals	Protect the knee and surgical incision Recover from swelling and inflammation Control of post-surgical pain
Precautions	Non-weight bearing on crutches Full time brace
Brace	Locked in full extension
Recommendations	At rest the brace can be loosened to allow swelling and discomfort to settle Ice the knee up to 3 times a day – particularly in the first 72 hours Sleep in the brace Range of motion exercises of ankle Range of motion exercises of hip
Suggested exercises	Static quads contraction Supine straight leg raise Ankle pumps Supine knee extension – foot elevated/supported – gravity only – no forced extension No hamstring stretching

Phase 1	Week 2 to week 6
Goals	Recover from swelling and inflammation Control of post-surgical pain Gain control of the leg Begin gaining flexion (0-90 by week 6)
Precautions	Touch weight-bearing Leg can rest on the floor when stationary No hamstring tretching
Brace	Full extension when mobilising Brace can be unlocked at rest – sitting or supine and when performing range of motion exercises Sleep in brace At rest the brace can be loosened to allow swelling and discomfort to settle
Recommendation	Passive range of motion (flexion and extension) as able- Hip and gluteal muscle strengthening Ankle range of motion.
Suggested exercises	Static quads contraction Supine straight leg raise Ankle pumps Supine bed supported knee bend Sitting supported knee bend Side leg raise – knee straight brace locked Supine knee extension – foot elevated/supported – gravity only – no forced extension No hamstring stretching

Phase 2	Week 7 to week 12
Goals	Full weight bearing Increase flexion to 125 degrees
Precautions	Brace is worn for all weight-bearing Continue to use crutches
Brace	Brace locked in extension for all weight-bearing weeks 6-8 Brace unlocked weeks 8 Dynamic PCL brace to be worn for all exercises, training and mobilising until week 18 Can be removed when sitting Can come off to sleep
Recommendations	Gradually begin taking weight through your leg when you walk. Fully weight bear as able (1-2 weeks)(with brace on) At rest and when doing exercises the brace can be fully unlocked and allow free range of flexion No hamstring stretches No Hamstring strengthening Hip and gluteal muscle strengthening Ankle and calf strengthening Passively stretch knee from full extension to full flexion (aim for 125 degrees flexion by 12 weeks) Allow no hyper-extension
Suggested exercises	Wall slide mini squat Double leg squats (0-60) Sitting unsupported knee extension and flexion Single leg stance – knee straight, knee flexed Straight leg raise Step ups Double calf raises – progress to single calf raise Side leg raise – knee straight, knee flexed Gluteal band exercises Bridging with gluteal contraction Exercycle – low resistance, short interval

Phase 3	3 Months – 6 months
Goals	Gain full function and strength
Precautions	No isolated hamstring strengthening before week 18 No open chain hamstring strengthening before week 18 No isolated hamstring stretching before week 18
Brace	Dynamic PCL brace to be worn for all exercises, training and mobilising until week 18
Recommendations	Concentrated full rehab program that includes strengthening of core, hip flexors, gluteal muscles, external rotators of the hip, quadriceps, and calves. Gain in confidence during athletic activity. Neuromuscular control and co-ordination of leg
Suggested exercises	Double leg squats (0-90) Single leg squats Single leg hop (after week 18) Step ups – increase height Hop ups Step downs (after 18 weeks) Hop downs (after 18 weeks) Side hops Resisted quads weight training Resisted hamstring weight training (after 18 weeks) Gluteal band exercises Bridging Double calf raises – progress to single calf raise Exercycle – increase resistance and training length