Posterior Cruciate Ligament (PCL) Rehabilitation Protocol – Kevin Kaplan MD

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

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