Posterior Cruciate Ligament (PCL) Rehabilitation Protocol

By Kevin M. 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

Telemedicine

All JOI Physicians, Physical Therapists and Occupational Therapists now offer Telemedicine services for virtual visits from the convenience of your home. Download the free Zoom app on the your phone, tablet or laptop. Also, our physicians and Telehealth for Physical Therapy can evaluate you and provide the care you need.

• To schedule a new patient or follow up patient appointment with your MD, please call (904)JOI-2000 or read more here about our orthopedic telemedicine providers.
• To schedule an appointment for physical or occupational therapy, call any of the 12 area JOI Rehab Centers.

JOI Fracture and Injury Care

JOI Physicians are currently offering ASAP Fracture care. Make an appointment by calling (904)JOI-2000. This is a new option for patients who would like to avoid the emergency room if they have suffered a fracture or soft tissue injury. Also, to learn more about this service, read this article about fracture and injury care.