Department of Rehabilitation Services 1
( ) Rehabilitation Guidelines
Department of Rehabilitation Services
Rehabilitation Guidelines for Arthroscopic Posterior Cruciate Ligament
Reconstruction
Indications: A posterior cruciate ligament (PCL) reconstruction is indicated when a traumatic injury
causes a tear in the PCL. It usually occurs in combination with other ligament tears, i.e. ACL or MCL, of
the knee. Surgery is indicated for persistent knee instability despite aggressive nonoperative management
and bracing.
Postoperative Rehabilitation:
Phase I: 0-5 weeks post-op
Treatment goals
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Minimize joint effusion
Independent use of cryocuff, range of motion brace and crutches
Cephalad glide of patella with quadriceps contraction
Minimize the effects of immobilization:
o protect against posterior tibial sagging
o Progressive Resistive Exercises(PRE) for the quad, hip and calf while limiting
patellofemoral joint compression and posterior tibial translation
Patient education
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Protect anatomical reconstruction with no tibial translation and no active hamstring contraction
Weight bearing as tolerated with brace locked at 0 degrees of extension until quad control is
achieved with continued use of crutches 4-6 weeks
Brace is unlocked for gait in a controlled environment only
Brace 0-90 for ROM activities
Exercise in pain free manner to avoid post-therapeutic exercise swelling
Therapeutic exercise
 ROM (0-90) :active extension and passive flexion, AAROM (wall slides or seated knee flexion
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using non-operative leg) ankle pumps, patellar mobs, gastroc-soleus stretch, scar mobs; may
begin prone passive knee flexion stretch with belt 2 weeks post-operatively
Strengthening exercises: SLR, quad isometrics, standing hip abduction, ankle pumps
Gait: WBAT. Lateral shifts with brace on at all times
Physical performance test:
 No joint effusion
 ROM of 0-90.
 Cephalad glide of patella with quadriceps contraction
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Phase II: 6-12 weeks post-op
Treatment goals
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Independent gait on all level surfaces
Full range of motion
Complete walking black exercise cord test
Fitted for functional PCL brace (6-8 weeks)
Patient education
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4-6 weeks: Brace is unlocked for gait in a controlled environment only
6-8 weeks: Brace is unlocked for all activity.
Patient will be WBAT with crutches progressing to WBAT without crutches.
Therapeutic exercises
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Warm up: Stationary bike
ROM: Patella mobilization, ankle pumps, long seated belt stretch, hamstring and gastroc-soleus
stretches, active knee flexion
Therapeutic exercises: phase one activities working on increasing flexion to120 degrees, entry
level black cord exercises except seated hamstring curl
o Walking exercise cord test:
6 weeks- forward/ backward walking, bilateral 1/3 knee bends
10 weeks -lateral stepping, unilateral knee bends, carpet drags
Pool (8 weeks): gait pattern, aqua jogging etc.
Gait Activities: Weight shifting (lateral, ant/lateral, step), short stride, heel to toe with gradual
increase of weight bearing on operative side
Physical performance test
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Pass walking black exercise cord test
Patient will have ROM 0-135.
Independent gait on all level surfaces
Phase III: 12 to 16 weeks post-op
Treatment goals
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Maximize strength through traditional strengthening and balance exercises
Advance aerobic conditioning
Add walking progression for distance and endurance
Add stationary or walking sport/activity specific drills
Pass running black exercise cord test/ LEFS test
Patient education
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Wear brace for all physical and at-risk activities
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Emphasize maximizing strength
Continue advancing aerobic conditioning
Therapeutic exercise
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Strength interval cycling / stair stepper progression focusing on slow to moderate speeds through
full range of motion
Dynamic balance
o Step up, step downs in multiple planes
o Step up, step downs, reverse step ups in multiple planes
o Multiplane lunges step up, step downs (non-weighted to weighted)
o Multiplane lunges step up, step downs, reverse step ups (non-weighted to weighted)
o Can add sport/activity specific implement /ball, drill
Strength training
Convert walking black cord test to running using interval format
o Use the 1 min to 30 sec. rest interval format
o Begin day one with 1 interval of each element and add one element each exercise day up
to 5 intervals
o Gradually decrease and eliminate rest times until achieving 5 min. continuous activity
for each of the 5 elements
Add sport/recreational specific drills
o Most sports/activities have drills that can be performed with or without balls that can be
performed in place or at walking pace.
o If in season, athletes can do these drills at practice after completing the home exercise
program
Add walking progression
o Performed after exercise session
o Advance based on success only
o Level surface walking, 12.5 minutes out and 12.5 min. back. Progress to a total of 45
minutes, 22.5 min. out 22.5 min back
o Hill walking beginning 12.5 min. out 12.5 min. back and progress up to 45 min. over
time
o Hiking
Physical performance test
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Successfully complete running black cord test at 16 ½ weeks post-op or LEFS test
o 25 min. total; 5 min. continuous activity each for forwards/backwards jogging, lateral
step and gather leading right/left, unilateral 1/3 knee bends on involved limb
Phase IV: 16-20 weeks post-op
Treatment goals
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Transform strength into power
Shift from aerobic to anaerobic training
Produce balanced take-offs and landings during all jumps and hops
Reduce running distances while increasing running intensity towards sprinting
Successfully complete jump testing
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Patient education
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Wear brace for all physical and at-risk activities
Emphasis is power development and L.E. and trunk alignment during take-off and landing during
all jumps and hops
Work to rest ratio is 1:3 for strength schedule and 1:4 or 1:5 for power schedule
Add running progression and transfer to sport/activity- specific drills
Therapeutic exercise
Performed in sequence on split schedule, i.e. strength and power schedules
 Strength Schedule is 1x/day 4days/week, i.e. Mon., Tuesday, Thurs., and Fri.
o Dynamic Balance
 Multi-plane jumps, progressed to holds
 Multi-plane hops, progressed to holds
 Multi-plane jumps and hops with sport/activity implement or ball
o Strength exercises
 Multi-plane lunges with weight 2 sets x 5 reps.
 Squats (knee flexion no greater than 85 degrees), leg press (knee flexion no
greater than 85 degrees), and hamstring curls progressed to 80 to 85 % of 2 RM
 Add push press and/or cleans at 65 to 70 % of 2 RM
 Continue unilateral 1/3 knee bends
o Success-based running progression (no sprinting)
 Walk turns, jog straights beginning with 800m adding 400m each strength day
until 2 miles completed
 Complete following sequence; 1-800m strides/runs, recover breath; 2-400 m
run/strides and recover breath; 2-200m strides/run
 Complete following sequence; 1-400m runs recover breath; 2-200m runs and
recover breath; 2-100m runs and recover breath; 2-50m runs
 Power Schedule is 1x/day 1 day/week
o Phase 1 Jump training *Sportsmetrics
o Performed on padded surface, emphasizing soft landing (catching), toes to heels, bending
ankles, knees, hips; keeping knees over feet, shoulders over knees
 Wall jumps 20 seconds
 Tuck jumps 20 seconds
 Squat jumps 15 seconds
 Side to Side barrier jumps (6” barrier) 20 seconds
 Front to back barrier jumps (6” barrier) 20 seconds
 180 degree turn jumps 20 seconds
 Long jumps 10 repetitions with 5 second hold
 Bounding in place 20 seconds
o Plyometric jumps
 From 8 to 10 inch height
 Landing pad
 Jump off box, soft landing and jump, soft landing and hold “catch” position for 5
seconds
 Optional
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o
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Rollerblading
Golfing
Physical performance test
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Successful completion of 3 jump tests
o Symmetrical hop for distance test
o Hop, hop, hop to 5 sec hold
o SHARK test
Phase V: 20 -24 weeks post-op
Treatment goals
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Begin gradual return to full activity
Return to sport/activity specific drills
Successfully complete the lower extremity functional (LEFT) test
Independent with home exercise program
o In-season performance
o Out-of season performance
Patient education
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Wear brace for all physical and at-risk activities
Emphasis is power development
Continued emphasis on anaerobic training
Emphasize L.E. and trunk alignment with all jumps and hops
Work to rest ratio is 1:3 for strength schedule and 1:4 or 1:5 for power schedule
Split schedule training; strength training 1x/day, 3 days/week and power 1x/day, 2 days/ week
Two full days of recovery
Completion of physical performance tests reported to physician by physical therapist / athletic
trainer.
Interscholastic athletes may require written approval from the physician to return to full
unrestricted athletics
Therapeutic exercise
Performed in sequence on strength and power schedules
 Strength schedule is 1x/day, 3 days/week
o Multiplane lunges performed in full range of motion at increasingly faster, but safe speeds
o Squats, leg press, hamstring curls, cleans at 85% to 90 % of 2 RM
o Running 1-400m run, 2-200m runs, 2-100m runs, 2-50m runs
 Power Schedule is 1x/day, 2days/week
o LEFT test progression based on success
 50 ft. x 30 ft. jog to sprint
 40 x 20 jog to sprint
 30 x 10 jog to sprint
o Continue Phase I jump training as outlined in Phase IV of protocol
Physical performance test
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Successful completion of LEFT test in allotted time
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References
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