Posterior cruciate ligament reconstruction

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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
  • No hamstring stretches

 

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 stretching or strengthening

 

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

 

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