Medial Collateral Ligament Repair or Reconstruction

Days 1–14

Exercises

• Dressing – POD 1: Debulk dressing, TED Hose in place
  • POD 2: Change dressing, keep wound covered, continue TED Hose
  • POD 7–10: Sutures out, D/C TED Hose when effusion resolved
• Brace x 8 weeks – Locked in extension for ambulation
• Crutches – Partial weight bearing (PWB) in brace (no more than 50% of body weight)
• Patellar mobilization (teach patient)
• Calf pumping
• AAROM, AROM 0–90 degrees
• Passive extension with heel on bolster or prone hangs
• Electrical stimulation in full extension with quad sets and SLR
• Quad sets, Co-contractions quads/hams
• Straight leg raise (SLR) x 3 on mat in brace – No ADD
• Short arc quads
• No stationary bike x 6 weeks
• Ice pack with knee in full extension after exercise

Goals

• Pain/effusion control
• Good quad control

Weeks 2–4

Exercises

• Brace x 8 weeks – Open to 0–45 degrees
• Crutches – PWB in brace
• Continue appropriate previous exercises
• Scar massage when incision healed
• AAROM, AROM 0–90 degrees only
• Total Gym for ROM (level 1–3)
  • Passive flexion to 90 degrees (push up with opposite leg)
• SLR x 3 on mat, no brace if good quad control – No ADD
• Double leg heel raises
• No stationary bike x 6 weeks
• Stretches – Hamstring, Hip Flexors, ITB

Goals

• ROM 0–90 degrees
• No extensor lag

Weeks 4–6

Exercises

• Brace x 8 weeks – Open to 0–90 degrees
• Crutches – PWB in brace
• Continue appropriate previous exercises
• AAROM, AROM 0–120 degrees
• Standing SLR x 3 with light Theraband bilaterally
  • May begin Hip ADD with Theraband if good LE control in full extension
• Total Gym (level 3–5) – Mini squats 0–45 degrees
  • Passive flexion to 90 degrees (push up with opposite leg)
• Leg press 0–45 degrees with resistance up to ¼ body weight
• Hamstring curls 0–45 degrees – Carpet drags or rolling stool (closed chain)
• No stationary bike x 6 weeks

Goals

• ROM 0–120 degrees
• No effusion

Weeks 6–8

Exercises

• Brace – Open to full range
• Crutches – Weight bearing as tolerated (WBAT), D/C crutch when gait is normal
• Continue appropriate previous exercises
• PROM, AAROM, AROM to regain full motion
• Standing SLR x 4 with light Theraband bilaterally
• Wall squats 0–45 degrees
• Leg press 0–60 degrees with resistance up to ½ body weight
• Hamstring curls through full range – Carpet drags or rolling stool
• Forward, lateral and retro step downs in parallel bars
  • No knee flexion past 45 degrees (small step)
• Proprioceptive training – Single leg standing in parallel bars
  • Double leg BAPS for weight shift
• Single leg heel raises
• Treadmill – Forwards and backwards walking
• Stationary bike – Progressive resistance and time
• Elliptical trainer

Goals

• Full ROM

Weeks 8–12

Exercises

• D/C Brace
• Continue appropriate previous exercises with progressive resistance
• Leg press 0–90 degrees with resistance as tolerated
• Hamstring curls on weight machine
• Knee extension weight machine
• Forward, lateral and retro step downs (medium to large step)
• Proprioceptive training – Single leg BAPS, ball toss and body blade
  • Grid exercises
• Treadmill – Walking progression program
• Stairmaster – Small steps
• Pool therapy

Goals

• Walk 2 miles at 15 min/mile pace

Months 3–4

Exercises

• Continue appropriate previous exercises
• Fitter
• Slide board
• Functional activities – Figure 8s, gentle loops, large zigzags
• Treadmill – Running progression program
• Pool therapy – Swimming laps
• Quad stretches

Goals

• Run 2 miles at easy pace

Months 4–6

Exercises

• Continue appropriate previous exercises
• Agility drills / Plyometrics
• Sit-up progression
• Running progression to track
• Transition to home / gym program

Goals

• Return to all activities
• Pass a return-to-sport / fitness test at 6 months post-op
• No contact sports until 6 months post-op

Home exercise sheet · knee phase 1

Perform exercises below frequently: 30 reps 3–5x a day

• Quad Isometrics
• Heel Slides
• Active Assisted Motion
• Ice Position 15 minutes 2–3 x per day

Abbreviations

AROM / AAROM / PROM: active / active-assisted / passive range of motion. ROM: range of motion. ER / IR: external / internal rotation. ABD / ADD: abduction / adduction. FLEX / EXT: flexion / extension. WBAT / PWB / TTWB / NWB: weight bearing as tolerated / partial / toe-touch / non-weight bearing. SLR: straight leg raise. HS: hamstrings. ITB: iliotibial band. UE / LE: upper / lower extremity. UBE: upper body ergometer (arm bike). BAPS: balance board. BFR: blood flow restriction training. PREs: progressive resistance exercises. D/C: discontinue. prn: as needed. POD: post-operative day. TENS: transcutaneous electrical nerve stimulation. ADLs: activities of daily living.

Source

Adapted from William Beaumont Army Medical Center, Physical Therapy Section, "MCL Repair WB08", Revised August 2008, published by William Beaumont Army Medical Center (a work of the U.S. Government in the public domain). Original: MCL Repair WB08.pdf. Army-specific wording in the original (APFT) was replaced with civilian equivalents.

This protocol is general guidance for the rehabilitation team and does not replace the specific plan, restrictions and follow-up we set together. Your own situation may differ: if anything here does not match what we talked about, what we talked about wins, so please ask me.

Current version and every other protocol: aaronweymd.com/post-op-protocols