Reprinted with permission from elsevier limited fig. Posterior cruciate ligament pcl reconstruction postoperative protocol. Pdf to create a rehabilitation protocol following reconstruction of the. Wulf, md posterior cruciate ligament reconstruction. Posterior cruciate ligament reconstruction postoperative rehabilitation protocol the range of motion allowed after posterior cruciate ligament reconstructive surgery is dependent upon the stability obtained at the time of surgery. Thus, to prevent this complication, one must have divergent tunnels. Immobilizer 3 days in extension until patient can transition into pcl brace pcl jack brace to be worn at all times, including rehabilitation and sleep minimum of 24 weeks goals pcl ligament graft protection ckdema reduction to improve passive rom and quadriceps activation address gait mechanics patient education therapeutic exercise. Locked in ful extensi on r ambulation and sleeping 14 weeks.
Acl reconstruction rehabilitation protocol peter j. The intent of this protocol is to provide the clinician with a guideline for the postoperative rehabilitation course of a patient that has undergone a pcl or pclacl reconstruction. Ranges of motion of 90 and 120 were allowed at 48 and 612 weeks postoperatively in 70 % of studies. Arthroscopic pcl inlay reconstruction with achilles tendon allograft feat. Rehabilitation of pcl injuries, whether following surgery or as part of a nonop erative protocol, focuses specifically on quadriceps strengthening and recovery of. Sep 29, 2016 tibial fractures are a rare complication of pcl reconstruction.
By metcalf memorial meeting 2010 featuring darren johnson. Begin scar massage after incision site sloughsscar is formed. Consider brace for exercise and periods of activity if. Frequent use of cryocuff andor ice with lower extremity elevated. Isolated or combined pcl injuries rehabilitation following surgical reconstruction. Download pdf, 32kb tibial stress fractures rehab protocol. Rehabilitation after posterior cruciate ligament reconstruction.
Patients who underwent pcl reconstruction between 2002 and 2010 were included. Reprinted with permission from elsevier limited several techniques have been developed to decrease the risk. Injuries of the posterior cruciate ligament pcl occur less frequently than those of the anterior cruciate ligament acl. Rehabilitation guidelines for posterior cruciate ligament. No open chain hamstring strengthening or isolated hamstring exercises. It is by no means intended to be a substitute for ones clinical decision making regarding the progression. Edema control continue edema control until edema resolves typically 4. Acl reconstruction rehabilitation protocol 4 control pain and swelling crushed ice or an aircast knee cryocuff along with nonsteroidal antiinflammatory medications such as advil, nuprin, motrin, ibuprofen, aleve 2 tablets twice a day are used to help control pain and swelling. This protocol is for patients who have undergone pcl reconstruction. Rehabilitation protocols help patients most in noting the specific timing of activities and exercises relevant to their condition. Pdf rehabilitation after posterior cruciate ligament reconstruction. Posterior cruciate ligament rehabilitation protocol it is important to understand that all time frames are approximate and that progressions should be based on individual monitoring. Physiotherapy following acl reconstruction protocol rehabilitation following anterior cruciate ligament reconstruction aclr is an essential part of a full recovery. Millett, md, msc steadman hawkins clinic vail, colorado slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
Pcl reconstruction protocol brigham and womens hospital. Perform pres with tibia in internal rotation during early postop period to decrease mcl stress. Begin patellar mobilizations 10 reps each direction tid. Millett, md, msc steadman hawkins clinic vail, colorado. Department of rehabilitation services physical therapy pcl reconstruction protocol the intent of this protocol is to provide the clinician with a guideline for the postoperative rehabilitation course of a patient that has undergone a pcl or pclacl reconstruction. Unlocked for ambulation, remove for sleeping as tolerated quad sets, patellar mobs, gas trocsoleu s etch slr w brace in full extension.
Surgical reconstruction is indicated in patients with pcl injuries that are. Range of motion exercises are initiated at the surgeons discretion in the initial six weeks postoperatively. Pcl repair rehab protocol patients are weight bearing as tolerated with crutch use as needed postoperatively range of motion will be blocked from 0 20 in a brace for adls and all exercises for 4 weeks. Loss of knee extension has been shown to result in a limp, quadriceps muscle weakness, and anterior knee pain. Medial collateral ligament and mpfl repair rehabilitation protocol. Complications and pcl reconstruction musculoskeletal key. Medial collateral ligament and mpfl repair rehabilitation. It is by no means intended to be a substitute for ones clinical decision.
Edema control continue edema control until edema resolves typically 4 weeks or less. Immediate postop no passive extension or passive flexion exercises gentle arom or aarom knee flexion is permitted within md limitations usually 90 degree limit for the first 6 weeks and then slow rom progression as the capsular. The intent of this protocol is to provide the clinician with a guideline for. In total there are 177 newly revised and expanded protocols for nonoperative and postoperative rehabilitation of the shoulder, elbow, hip, knee, foot, and ankle, plus exercise handouts and interval return to sport programs. Early activity following pcl repair can lead to increased laxity. Com physical therapy protocol pcl reconstruction preoperative brace.
Pcl rehab sports medicine orthopedic surgeon houston, tx. Acl reconstruction protocol1 northwestern medical center. Injury to the pcl can often be managed with nonoperative treatment. Standardized followup was performed between 2012 and 20 and consisted of subjective scores tegner activity score, knee injury and osteoarthritis outcome score koos, and subjective international knee documentation committee ikdc score and objective measures, including knee laxity kt. The pcl reconstruction rehabilitation is unique in that extreme knee flexion places a higher. Standardized followup was performed between 2012 and 20 and consisted of subjective scores tegner activity score, knee injury and osteoarthritis outcome score koos, and subjective international knee documentation committee ikdc score and objective measures, including knee laxity kt, extension. Posterior cruciate ligament pcl reconstruction rehabilitation protocol the following is a protocol for postoperative patients following pcl reconstruction.
Pcl reconstruction protocol the intent of this protocol is to provide the clinician with a guideline for the postoperative rehabilitation course of a patient that has undergone a pcl or pclacl reconstruction. Lowe this rehabilitation protocol has been developed for the patient who has posterior cruciate ligament pcl reconstruction using a secure graft with internal fixation. Goals are to develop maximal strength, power and advance to sporting activities. Posterior cruciate ligament reconstruction rehabilitation protocol dr. Return to low impact activities, slow progression to higher impact activities. Acl reconstruction should be performed once the knee has recovered from the acute injury, has a full range of motion, and is pain free in order to optimise the outcome and avoid complications such as knee sti. Consider brace for exercise and periods of activity if severe sprain andor patient has pain.
To create a rehabilitation protocol following reconstruction of the. Fit for functional pcl brace to be used for sporting activities and more ballistic rehabilitation training. Pcl nonoperative rehabilitation protocol page 1 of 3 bart eastwood d. Isolated posterior cruciate ligament reconstruction. Post operative rehabilitation program for anterior cruciate ligament reconstruction this protocol is designed to assist you with your rehabilitation after surgery and should be followed under the direction of a physiotherapist. Acl reconstruction rehab protocol the following is a protocol for postoperative patients following acl reconstruction.
The aim of this study is to report the results of a consecutive series of patients who underwent the same surgical technique for isolated pcl reconstruction and were. The primary goal of this protocol is to protect the reconstruction while steadily progressing towards. Patients are weight bearing as tolerated with crutch use as. Reconstruction surgery of the posterior cruciate ligament pcl has not yet been fully standardized, and associated rehabilitation protocols have not been clearly defined. The primary goal of this protocol is to protect the reconstruction while steadily progressing towards and ultimately achieving preinjury level of activity. Arthrex provides a comprehensive line of pcl reconstruction instrumentation options for a variety of pcl reconstruction techniques. The most common cause of pcl tears figure 3 are sports injuries 37% and trauma 56%. Posterior cruciate ligament pcl reconstruction rehabilitation program introduction the posterior cruciate ligament pcl is the strongest ligament in the knee.
When reconstruction is the treatment of choice, the anterolateral component of the pcl is the focus due to its superior structural properties over the posteromedial band. Posterior cruciate ligament rehabilitation protocol. Acl reconstruction should be performed once the knee has recovered from the acute injury, has a full range of motion, and is pain free in order to optimise the. Mcl injury restrict motion to sagittal plane until week 46 to allow healing of mcl. The newest anatomic pcl retroconstruction guide reduces the challenge of pcl footprint targeting while simultaneously acting as a backstop to protect the neurovascular bundles. It is also seen in doublebundle pcl reconstruction or combined acl pcl reconstructions if the tunnels converge.
The primary goal of this protocol is to protect the reconstruction while steadily progressing towards and ultimately achieving preinjury level of. Begin the first 3 exercises below and add others gradually as tolerated. This protocol is intended to provide the user with instruction, direction, rehabilitative guidelines and functional goals. Alaia, md assistant professor of orthopaedics division of sports medicine tel. Chapter 41 posterior cruciate ligament reconstruction 477 relaxing patterns are different in varying positions of the knee. If there is a combined reconstruction involving both the pcl and the acl, then rehabilitation will progress according to the isolated pcl protocol.
Posterior cruciate ligament reconstruction center for sports. Posterior cruciate ligament pcl reconstruction post. Nov 08, 2012 acl reconstruction rehabilitation protocol peter j. The pcl is tight when the knee is bent, so most pcl injuries occur at that time.
Posterior cruciate ligament pcl reconstruction rehabilitation. Promote tissues healing decrease pain decrease effusion increase strength, endurance and power improve proprioception and enhance dynamic stability reduce functional limitations and disability treatment. Physical therapy protocol pcl reconstruction postoperative. Posterior cruciate ligament tears robert laprade, md. Acl reconstruction rehabilitation protocol one of the most common complications following acl reconstruction is loss of motion, especially loss of extension. Posterior cruciate ligament pcl reconstruction postoperative. Rehabilitaion protocol for posterior cruciate ligament.