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Phase I: Immediate Postoperative Phase (Weeks1-4)

Goals:

  • Wound healing
  • Quadriceps activation
  • Decrease effusion
  • Restore full extension
  • Normalize patella mobility
  • Initiate proximal strengthening

Restrictions:

  • WBAT with crutches with brace locked at 0
  • D/C crutches after a few days unless radial tear (will be specified by physician)
    • ┬áKeep brace locked at 0 when not in therapy/exercising
  • Range of motion (ROM), motion is limited to 0-70 for 4 weeks,

Treatment:

  • Ice, compression, elevation
  • Electrical muscle stimulation
  • Scar tissue mobilization
  • Active assisted ROM
  • Strengthening
  • Quadriceps isometrics
  • Hamstring isometrics
  • Hip abduction/adduction

Clinical Milestones:

  • +1 effusion
  • Good quadriceps set
  • Good patella mobility
  • Painfree at rest
  • AROM 0-70
  • Single limb stance

Phase II Intermediate Postoperative Phase (Weeks 4-6)

Goals:

  • WBAT with crutches with brace locked from 0-90
  • Progress to closed kinetic chain exercises
  • Avoid Patellar pain

Restrictions:

  • Gradual increase in flexion ROM (based on pain assessment) to 90 degrees
  • D/C brace at 6wks

Treatment:

  • Pain Management
  • Control of effusion
  • Neuromuscular Re-ed of Quadriceps
  • Mini Squats
  • Step up's
  • Upper extremity reaches
  • ROM exercises
  • Flexibility exercises
  • Cardiovascular training
  • Toe raises
  • Cycling

Clinical Milestones:

  • FWB
  • Normal gait
  • AROM 0-90
  • Good quadriceps recruitment
  • Straight leg raise without lag
  • Normal patellar mobility

Phase III: Advanced Strengthening Phase (Weeks 6-10)

Goals:

  • Increase strength, power, endurance
  • Normalize knee ROM
  • Prepare athlete for advanced exercises

Restrictions:

  • Avoid pivoting
  • Flexion to 130
  • No squatting / No deep knee bends

Treatment:

  • Progress quadriceps strengthening exercises
  • Standing balance training
  • Effusion/edema reduction
  • Strengthening exercises
  • Upper extremity reaches
  • Lateral step-ups
  • Leg press
  • Step down's
  • Endurance exercises
  • Proprioception exercises
  • Flexibility exercises
  • Isokinetic exercises
  • Swimming
  • StairMaster
  • Minisquats
  • Cycling
  • Nordic Track

Clinical Milestones:

  • Improved stability with unilateral stance
  • Minimal to no pain
  • Achieve full ROM
  • Equal hip strength bilaterally
  • Isokinetic quadriceps strength < 20% contralateral

Phase IV: Return to Activity Phase (Weeks 11-16)

Goals:

  • Increase power and endurance
  • Emphasize return to skill activities
  • Prepare to return to full unrestricted activities

Restrictions:

  • Avoid hyperflexion

Treatment:

  • Strengthening exercises
  • Endurance exercises
  • Agility drills
  • Plyometric training
  • Sport specific drills
  • Initiate running program
  • Initiate cutting program

Clinical Milestones:

  • Full confidence in knee
  • Painfree activity at 5 months
  • Satisfactory clinical examination
  • Functional testing at least 90% of contralateral leg
  • Isokinetic testing least 90% of contralateral leg

Click here to download Printable Version of Guidelines Following PCL Reconstruction.