PCL 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 3 months – Locked in extension x 8 weeks
• Crutches – Partial weight bearing (PWB) in brace
• AAROM – 0–45 degrees
• Patellar mobilization (teach patient)
• Calf pumping
• Passive extension to 0 degrees, no hyperextension
  • Calf (not heel) on bolster or prone hangs with tibia supported
• Electrical stimulation in full extension with quad sets
• Quad sets, Co-contractions quads / HS
• Straight leg raise (SLR) x 4 on mat in brace (parallel bars if poor quad control)
• Ice Pack with knee in full extension after exercise

Goals

• AAROM 0–45 degrees
• Good quad control

Weeks 2–4

Exercises

• Brace x 3 months – Locked in extension x 8 weeks
• Crutches – PWB in brace
• Continue appropriate previous exercises
• AAROM – 0–60 degrees
• No Hamstring curls or Stationary bike x 8 weeks
• Scar massage when incision healed
• SLR x 4 on mat in brace – Add light weight above knee if good quad control
• Double leg heel raises in brace (supported in parallel bars)
• Weight shifts, Mini squats 0–30 degrees, in brace (supported in parallel bars)
• Stretches – AT, hip flexors, ITB
  • Hamstring with leg supported in brace

Goals

• AAROM 0–45 degrees
• No extensor lag

Weeks 4–6

Exercises

• Brace x 3 months – Locked in extension x 8 weeks
• Crutches – PWB in brace
• Continue appropriate previous exercises
• AAROM by patient 0–60 degrees
• No Hamstring curls or Stationary bike x 8 weeks
• Multi-angle Co-contractions quads / HS at 0, 20, 40, 60 degrees
• SLR x 4 on mat, out of brace, no weights

Goals

• AAROM 0–60 degrees
• No effusion

Weeks 6–8

Exercises

• Brace x 3 months – Locked in extension x 8 weeks
• Crutches – Weight bearing as tolerated (WBAT) in brace
• Continue appropriate previous exercises and the following ex without brace
• AROM, AAROM 0–90 degrees
• No Hamstring curls or Stationary bike x 8 weeks
• SLR x 4 on mat with light weight below the knee
• SAQ – 0–30 degrees over bolster with light ankle weights
• Double leg heel raises
• Wall squats 0–45 degrees
• Leg press 0–45 degrees with resistance no more than ¼ body weight
• Forward, retro and lateral step downs in parallel bars (small step)
• Proprioceptive training – Single leg standing in parallel bars
  • Double leg BAPS in parallel bars
• Elliptical trainer – No resistance

Goals

• AAROM 0–90 degrees

Weeks 8–12

Exercises

• Brace x 3 months – Open to available range
• Crutches – D/C when gait is normal
• Continue appropriate previous exercises
• AROM, AAROM 0–110 degrees
• Forward, retro and lateral step downs – medium step
• Single leg heel raises
• Leg Press – 0–60 degrees with resistance up to ½ body weight
• Hamstring curls – 0–60 degrees, with ankle weights prone or in standing
  • Progress to weight machine, 0–60 degrees (up to ¼ body weight)
• Hip weight machine x 4 bilaterally
• LAQ 0–60 degrees over bolster or side of mat with ankle weights
• Proprioceptive training – Single leg BAPS, ball toss and body blade
• Stationary bike for ROM – No resistance
• Treadmill – Forwards and backwards walking
• Elliptical Trainer with minimal resistance
• Pool therapy – Walking / running (no kicking)

Goals

• AROM 0–110 degrees
• Normal gait

Months 3–4

Exercises

• D/C ROM brace
• Functional brace per surgeon
• Continue appropriate previous exercises with progressive resistance
• PROM, AAROM, AROM to regain full motion
• Leg press 0–90 degrees with resistance as tolerated
• Hamstring curl weight machine 0–90 degrees with low weight and high reps
• Knee extension weight machine through full range with resistance as tolerated
• Fitter
• Slide board
• Stationary bike – Progressive resistance and time
• Elliptical trainer for progressive resistance and time
• Treadmill – Walking progression program
• Pool therapy – Swimming laps

Goals

• Full ROM
• Walk 2 miles at 15 min/mile pace

Months 4–6

Exercises

• Biodex at 6 months depending on patient progress and surgeon request
• Continue appropriate previous exercises
• Agility drills / Plyometrics
• Sit-up progression
• Treadmill – Running progression program
• Quad stretches
• Transition to home / gym program

Goals

• Run 2 miles at easy pace
• Return to all activities and pass a return-to-sport / fitness test at 9 months post-op
• No contact sports until 9 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, "PCL WB08", Revised August 2008, published by William Beaumont Army Medical Center (a work of the U.S. Government in the public domain). Original: PCL 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