Posterior Cruciate Ligament (PCL) Rehabilitation Protocol – Kevin Kaplan MD
Posterior Cruciate Ligament Rehab Phase I (Weeks 0-4)
- Weight bearing: As tolerated with crutches (may be modified if concomitant posterolateral corner reconstruction, meniscal repair/meniscal transplant or articular cartilage procedure is performed)
- Hinged Knee Brace:
- Locked in full extension for ambulation and sleeping (Weeks 0-1)
- Locked in full extension for ambulation – removed for therapy sessions (Weeks 1-4)
- Range of Motion – Weeks 0-1: None, Weeks 1-2: PROM 0-30°, Weeks 2-4: PROM 0-90° (MAINTAIN ANTERIOR PRESSURE ON PROXIMAL TIBIA AS KNEE IS FLEXED FROM WEEK 1-4—NEED TO PREVENT POSTERIOR SAGGING AT ALL TIMES)
- Therapeutic Exercises
- Quad/Hamstring sets and ankle pumps
- Straight-Leg Raise with brace in full extension until quad strength prevents extension lag
- Hip abduction/adduction (RESISTANCE MUST BE PROXIMAL TO THE KNEE)
- Hamstring/Calf stretch – Calf press with Thera Band progressing to standing toe raises with knee in full extension
Phase II (Weeks 4-12)
- Weight bearing: As tolerated with crutches– discontinue crutch use at 6-8 weeks post-op
- Hinged Knee Brace: Weeks 4-6: unlocked for gait training/exercise only, Weeks 6-8: unlocked for all activities, Discontinue brace at 8 weeks post-op
- Range of Motion–Maintain full knee extension–work on progressive knee flexion (Goal of 110° by week 6)
- Therapeutic Exercises
- Weeks 4-8: Gait training, wall slides (0-30°), Mini-squats (0-30°), Leg press (0-60°)
- Weeks 8-12: Stationary bicycle (with seat higher than normal), Stairmaster, Closed-chain terminal knee extension, Leg press (0-90°), Balance and proprioception activities
Phase III (Weeks 12-9 months)
- Weight bearing: Full weight bearing with normalized gait pattern
- Range of Motion – Full/Painless ROM
- Therapeutic Exercises
- Advance closed chain strengthening exercises, progress with proprioception/balance activities
- Maintain flexibility
- Begin treadmill walking – progress to jogging
Phase IV (9 months and beyond)
- Maintain strength, endurance and function – initiate plyometric program
- Begin cutting exercises and sport-specific drills
- Return to sports as tolerated
