knee rehabilitation - physical therapy protocols

8/11/2019 Knee Rehabilitation - Physical Therapy Protocols

1/21

Kevin B. Freedman, M.D.Sports Medicine

27 South Bryn Mawr Ave

Bryn Mawr, PA 19010-3470

Phone: (610) 527-2727

Fax: (610) 527-1588

AUTOLOGOUS CHONDROCYTE IMPLANTATION(FEMORAL CONDYLE ONLY)

REHABILITATION PROTOCOL

WEIGHT BRACE ROM THERAPEUTIC

BEARING EXERCISE

PHASE I 0-2 weeks: non- 0-2 weeks: locked in 0-4 weeks: 0-2 weeks: Quad sets, SLR,

0 - 12 weeks weight bearing full extension (removed CPM: use in hamstring isometrics - complete

for CPM and exercise) 2 hour in- exercises in brace if quad control

2-4 weeks: partial 2-4 weeks: Gradually crements for is inadequate

weight bearing - open brace 20 a t a 6 - 8 hours 2-6 weeks: Begin progressive

(30 - 40 lbs) time as quad control per day at 1 closed chain exercises*

4-6 weeks: is gained - discontinue cycle/minute - 6-10 weeks: Progress bilateral

progress to use use of brace when quads begin at 0-30 closed chain strengthening, begin

of one crutch can control SLR without increasing opened chain knee strengthening

6-12 weeks: an extension lag 5-10 daily per 10-12 weeks: Progress closed

progress to full patient comfort - chain exercises using resistance

weight-bearing patient should less than patient's body weight,

gain at least 90 progress to unilateral closed

by week 4 and chain exercises, begin balance

120-130 by activit ies

week 6

PHASE II Full with a None Full active Advance bilateral and unilateral

12 weeks - normalized range of closed chain exercises with

6 months gait pattern motion emphasis on concentric/eccentric

control, continue with biking, stairmaster

and treadmill, progress balance activities

PHASE III Full with a None Full and Advance strength training, initiate

6 - 9 months normalized pain-free light plyometrics and jogging - start with

gait pattern 2 minute walk/2 minute jog, emphasize

sport-specific training

PHASE IV Full with a None Full and Continue strength training - emphasize

9 - 18 months normalized pain-free single leg loading, begin a progressive

gait pattern running and agility program - high impact

activities (basketball, tennis, etc.) may

begin at 16 months if pain-free

*Respect chondrocyte graft site with closed chain activities:

If anterior - avoid loading in full extension

If posterior - avoid loading in flexion >45

**If pain or swelling occurs with any activities, they must be modified to decrease symptoms


2/21




Phone: (610) 527-2727

Fax: (610) 527-1588

AUTOLOGOUS CHONDROCYTE IMPLANTATION(TROCHLEA/PATELLA)*



BEARING EXERCISE

PHASE I 0-6 weeks: non- 0-2 weeks: locked in 0-4 weeks: 1-4 weeks: Quad sets, SLR,

0 - 12 weeks weight bearing full extension (removed CPM: use in hamstring isometrics - complete

for CPM and exercise) 2 hour in- exercises in brace if quad control

2-4 weeks: Locked crements for is inadequate

at 0 f or ambulating 6 - 8 hours 4-10 weeks: beginisometric

per day - begin closed chain exercises - at 6-10

6-8 weeks: 4-6 weeks: Begin to at 0-30 - 1 weeks, may begin weight shifting

advance to open 20 to 30 with cycle/minute - activit ies with involved leg extended

partial weight bear ambulation - discontinue after week 3, if full weight bearing - at 8 weeks begin

status - progress use after 6 weeks increase balance activit ies and stationary bike

to use of one flexion by 5 - with light resistance

crutch 10 daily 10-12 weeks: hamstring

8-12 weeks: 6-8 weeks: strengthening, theraband 0-30

progress to full gain 0-90 resistance, light open chain

weight bearing and 8 weeks: knee isometrics

discard crutches gain 0-120

PHASE II Full with a None Full range Begin treadmill walking at a slow

12 weeks - normalized of motion to moderate pace, progress

6 months gait pattern balance/proprioceptive activities,

initiate sport cord lateral drills

PHASE III Full with a None Full and Advance closed chain strengthening,

6 - 9 months normalized pain-free initiate unilateral closed chain exercises,

gait pattern progress to fast walking and backward

walking on treadmill (initiate incline at

8-10 months), initiate light plyometric

activity




activities may begin at 16 months

if pain-free

*Most trochlear/patellar defect repairs are performed in combination with a distal realignment procedure, and thus weight bearing

is restricted for the first 4-6 weeks to protect the bony portion of the distal realignment during healing

**May consider patellofemoral taping or stabilizing brace if improper patella tracking stresses implantation

***If pain or swelling occurs with any activities, they must be modified to decrease symptoms


3/21

NOTE: Post-operative stiffness in flexion following trochlear/patellar implantation is not uncommon and patients

are encouraged to achieve 90 of flexion at least 3x/day out of the brace after their first post-op visit (day 7-10)


4/21




Phone: (610) 527-2727

Fax: (610) 527-1588

ACL RECONSTRUCTION (PATELLA TENDON GRAFT)* WITH

AUTOLOGOUS CHONDROCYTE IMPLANTATION (FEMORAL CONDYLE)



BEARING EXERCISES

PHASE I 0-2 weeks: non- 0-2 weeks: locked in

0-4 weeks: 1-2 weeks: active/passive ROM,

0 - 12 weeks weight bearing full extension (removed CPM: use in active knee extension 90-60 ,

for CPM and exercise) 2 hour incre- quad/hamstring sets, SLR, begin

2-4 weeks: partial 2-6 weeks: gradually ments for 6 - active hamstring strengthening

weight bearing open 20 at a time 8 hours per 2-6 weeks: progress exercises in

(30 - 40 lbs) with as patient gains quad day, begin at phase I, add resistance above the knee,

crutches control - discontinue 0-30 , 1 begin closed chain exercises keeping

4-6 weeks: use of brace when cycle/minute - weight bearing restrictions in mind

progress to one patient has good after week 3, 6-10 weeks: weight shifting

crutch quad control, but no increase f lexion activit ies, progress closed chain

6-12 weeks: sooner than 6 weeks by 5-10 daily and hamstring strengthening,

progress to full forward/backward treadmill walking,

weight bearing begin Stairmaster

without crutches 10-12 weeks: progress closed chain

activities using resistance less than

patient's body weight, open chain knee

extension 90-30 , continue hamstring

strengthening, balance activities

PHASE II Full with a None Maintain full Advance closed chain exercises,

12 weeks - normalized active/passive begin full ROM active knee extension*,

6 months gait pattern range progress treadmill - initiate light jog

PHASE III Full with a None Full and Initiate slight incline with treadmill jog,

6 - 12 months normalized pain-free emphasize single leg loading, begin

gait pattern progressive running and agility program-

including sport-specific activities

*Monitor f or signs of patella femoral irritation


5/21




Phone: (610) 527-2727

Fax: (610) 527-1588

ACL ALLOGRAFT RECONSTRUCTION



BEARING EXERCISES

PHASE I As tolerated with 0-2 weeks: locked in As tolerated Heel slides, quad/hamstring sets,

0 - 2 weeks crutches* full extension for patellar mobs, prone hangs,

ambulation and sleeping gastroc/soleus stretch***,

SLR with brace in full

extension until quad strength

prevents extension lag

PHASE II Discontinue Discontinue use Maintain full Progress to weight bearing

2 - 6 weeks crutch use when patient has full extension and gastroc/soleus stretch, begin toe

extension and no progressive raises, closed chain extension,

extension lag flexion balance exercises, hamstring

curls, and stationary bike

PHASE III Full, without use None Gain full and Advance closed chain

6 weeks - of crutches and pain-free strengthening, progress

4 months with a normalized proprioception activities, begin

gait pattern Stairmaster/Nordic Trac and

running straight ahead at 12 weeks

PHASE IV Full None Full and Progress flexibility/strengthening,

4 - 6 months pain-free progression of function: forward/

backward running, cutting, grapevine,

etc., initiate plyometric program and

sport-specific drillsMay add open chain quad exercises

PHASE V Full None Full and Gradual return to sports participation,

6 months pain-free maintenance program for strength

and beyond and endurance

At patient's discression, a

functional ACL brace may be used

from 6 mo to 1 yr post-op

*Modified with concomitantly performed meniscus repair/transplantation or articular cartilage procedure

***This exercise is to be completed in a non-weight bearing position


6/21




Phone: (610) 527-2727

Fax: (610) 527-1588

ACL PATELLAR TENDON AUTOGRAFT RECONSTRUCTION



BEARING EXERCISES

PHASE I

0 - 4 weeks As tolerated with 0-2 weeks: locked in As tolerated Heel slides, quad/hamstring sets,

crutches* full extension for patellar mobs, prone hangs, gastroc/soleus

ambulation and sleeping stretch***, SLR with brace in full

2-4 weeks: unlocked extension until quad strength

for ambulation, remove prevents extension lag

for sleeping**

PHASE II

4 - 6 weeks Gradually Discontinue use when Maintain full Progress to weight bearing

discontinue patient has full extension and gastroc/soleus stretch, begin toe

crutch use extension and no progressive raises, closed chain extension,

extension lag flexion balance exercises, hamstring


PHASE III

6 weeks - Full, without use None Gain full and Advance closed chain

4 months of crutches and pain-free strengthening, progress

with a normalized proprioception activities, begin


running straight ahead at 12 weeks

PHASE IV

4 - 6 months Full None Full and Progress flexibility/strengthening,

pain-free progression of function: forward/



sport-specific drills

May add open chain quad exercises

PHASE V

6 months Full None Full and Gradual return to sports participation,

and beyond pain-free maintenance program for strength

and endurance

At patient's discression, a functional

ACL brace may be used for sports

*Modified with concomitantly performed meniscus repair/transplantation or articular cartilage pro from 6 mo to 1 year post-op



7/21




Phone: (610) 527-2727

Fax: (610) 527-1588

ACL HAMSTRING AUTOGRAFT RECONSTRUCTION



BEARING EXERCISE

PHASE I As tolerated 0-2 week: locked in As tolerated Heel slides, quad sets, patellar mobs

0 - 4 weeks with crutches* full extension for gastroc/soleus stretch***, SLR with

ambulation and sleeping brace in full extension until quad

strength prevents extension lag****

PHASE II Gradually Discontinue use when Maintain full Progress to weight bearing

4 - 6 weeks discontinue patient has full extension and gastroc/soleus stretch and closed

crutch use extension and no progressive chain activities, begin hamstring

extension lag flexion stretching

PHASE III Full, without use None Gain full and Begin hamstring strengthening, advance

6 weeks - of crutches and pain-free closed chain strengthening, progress


gait pattern Stairmaster/Nordic Trac, begin running

straight ahead at 12 weeks


4 - 6 months pain-free progression of function: forward/




PHASE V Full None Full and Gradual return to sports participation,6 months pain-free maintenance program for strengthand beyond and endurance

At patient's discression, a functional ACL

brace can be used from 6 mo to 1 yr post-op

*Modified with concomitantly performed meniscus repair/transplantation or articular cartilage procedure

**Avoid open chain quadriceps strengthening for first 4 months


****NO hamstring stretching until 4 weeks post-operative


8/21

Kevin B. Freedman, M.D.

Sports Medicine



Phone: (610) 527-2727

Fax: (610) 527-1588

HIGH TIBIAL OSTEOTOMY - OPENING WEDGE



BEARING EXERCISES**

PHASE I 0-6 Weeks:Non- Locked in full extension As tolerated - Heel slides 0 - 90 , quad sets,

0 - 6 weeks weight bearing with for all activities (including CPM*for 2 ankle pumps, calf/hamstring

crutches sleeping) - remove f or hours, twice stretches* **, SLR with brace

exercise and CPM use (if daily, from locked in full extension, resisted

applicable) 0 - 90 of plantarflexion

flexion out of

brace

PHASE II As tolerated with Unlocked for ambulation - Discontinue Progress exercises in phase I,

6 - 8 weeks crutches - begin to removed for sleeping CPM if knee SLR without brace if able to

advance to a flexion is at maintain full extension, initiate

normalized gait least 90 stationary bike with low resistance

pattern without

crutches

PHASE III Full, without use Discontinue use - per Gain full and Mini-squats 0-45 - progressing

8 weeks - of crutches and physician pain-free to step-ups, leg press 0-60 , closed

3 months with a normalized chain terminal knee extensions, toe

gait pattern raises, balance activities, hamstring

curls, increase to moderate resistance

on bike

PHASE IV Full None Full and Progress closed chain activities,

3 - 9 months pain-free begin treadmill walking, swimming, and

sport-specific activities

**No closed chain exercises until 6 weeks post-op



9/21




Phone: (610) 527-2727

Fax: (610) 527-1588

ARTHROSCOPIC LATERAL RELEASE



BEARING EXERCISES

PHASE I As tolerated with None As tolerated Heel slides, quad/hamstring sets,

0 - 2 weeks crutches patellar mobilization in all quadrants, prone

hangs, gastroc/soleus stretch*,

Straight leg raising, edema control

PHASE II Gradually None Maintain full Progress to normal gait pattern,

2 - 6 weeks discontinue extension and gastroc/soleus stretch, begin toe

crutch use progressive raises, closed chain extension,

flexion balance exercises, hamstring



6 weeks - of crutches and pain-free strengthening, progress



running straight ahead


3 months and pain-free progression of function: forward/

beyond backward running, cutting, grapevine,



Gradual return to sports participation,

maintenance program for strength

and endurance

* This exercise is to be performed in a non-weight bearing position


10/21


Sports Medicine



Phone: (610) 527-2727

Fax: (610) 527-1588

MENISCAL ALLOGRAFT TRANSPLANTATION



BEARING EXERCISE**

PHASE I 0-2 weeks: partial 0-1 week: locked in 0-2 weeks: 0-2 weeks: Heel slides, quad sets,

0 - 8 weeks weight bearing - f ull extension for non-weight patellar m obs, SLR, SAQ

(up to 50%) sleeping* bearing 0-90 2-8 weeks: addition of heel

2-6 weeks: as 0-2 weeks: locked in 2-8 weeks: raises, total gym (closed chain),

tolerated with extension f or all as tolerated, and term inal knee extensions -

crutches - weight bearing non-weight activities with brace until 6 weeks,

discontinue use activities bearing then without brace to tolerance

of crutches at 4 2-6 weeks: Locked NOTE: No weight bearing with

weeks when 0 - 90 - discontinue flexion >90 during phase I

gait normalizes brace after 6 weeks

PHASE II Full, without None Full active Progress closed chain activities, begin

8 - 12 weeks crutches range of hamstring work, lunges 0-90 of flexion,

motion proprioception exercises, leg press

0-90 - flexion only, begin stationary bike

PHASE III Full with a None Full and Progress phase II exercises and

12 - 16 weeks normalized pain-free functional activities such as:

gait pattern single leg hops, jogging to running

progression, plyometrics, slideboard,

and sport-specific drills

*Brace may be removed for sleeping after first post-operative visit (day 7-10)

**Avoid any tibial rotation for 8 weeks to protect meniscus


11/21




Phone: (610) 527-2727

Fax: (610) 527-1588

MICROFRACTURE - FEMORAL CONDYLE



BEARING EXERCISE

PHASE I Touchdown None Use of a CPM for Passivestretching/exercise

0 - 6 weeks weight bearing 6-8 hours/day - set for the first 6 - 8 weeks, quad/hamstring

(20-30%) for the at a rate of 1 cycle/ isometrics

first 6 weeks. minute, advancing 10

daily - begin at a level

of flexion that is

comfortable for the

patient - advance to

full flexion as tolerated

PHASE II Gradual return None Gain full and Progressive active strengthening

6 - 12 weeks to full weight pain-free

bearing

PHASE III Full None Full and pain-free Return to full activities, including

12 weeks cutting, turning, and jumpingand beyond


12/21




Phone: (610) 527-2727

Fax: (610) 527-1588

MICROFRACTURE - TROCHLEAR/PATELLAR DEFECT



BEARING EXERCISE

PHASE I W eight bearing Locked 0 - 30 Use of a CPM for Passivestretching/exercise

0 - 6 weeks as tolerated of f lexion for 6-8 hours/day - begin for the f irst 6 - 8 weeks, quad/hamstring

in brace weight bearing at a rate of 1 cycle/ isometrics

Unlocked when non- minute, ranging from

weight bearing 0 - 50, advance 10

degrees daily - advance

to full flexion as

tolerated

PHASE II Full None Gain full and Begin closed chain activities,

6 - 12 weeks pain-free emphasizing a patellofemoral program

PHASE III Full None Full and pain-free Return to full activities, including

12 weeks cutting, turning, and jumping

and beyond


13/21




Phone: (610) 527-2727

Fax: (610) 527-1588

MENISCAL ALLOGRAFT TRANSPLANTATION WITH

AUTOLOGOUS CHONDROCYTE IMPLANTATION



BEARING EXERCISE

PHASE I 0-4 weeks: non- 0-2 weeks: locked in 10 days - 4 0-2 weeks: Quad sets, SLR,

0 - 12 weeks weight bearing full extension (removed weeks: CPM - hamstring isometrics - completefor CPM and exercise) use in 2 hour exercises in brace if quad control

4-6 weeks: partial 2-4 weeks: Gradually increments for is inadequate

weight bearing - open brace 20 a t a 6 - 8 hours 2-6 weeks: Begin progressive

(30 - 40 lbs) time as quad control per day- begin closed chain exercises*

is gained - discontinue at 0-40 and 6-10 weeks: Progress bilateral

6-12 weeks: use of brace when increase by closed chain strengthening, begin

progress to full quads can control SLR 5-10 daily, as opened chain knee strengthening

weight bearing without extension lag. tolerated - 10-12 weeks: Progress closed

patient should chain exercises using resistance

gain full ROM less than patient's body weight,

by 12 weeks progress to unilateral closed chain

exercises, begin balance activities

PHASE II Full with a None Full active Advance bilateral and unilateral closed

12 weeks - normalized range of chain exercises with emphasis on

6 months gait pattern motion concentric/eccentric control, continue

with biking, Stairmaster, and treadmill,

progress balance activities

PHASE III Full with a None Full and Advance strength training, initiate

6 - 9 months normalized pain-free light plyometrics and jogging - start with

gait pattern a 2 minute walk/2 minute jog, emphasize

sport-specific training




activities (basketball, tennis, etc.) may

begin at 16 months if pain-free

*Respect chondrocyte graft site with closed chain activities:

If anterior - avoid loading in full extension

If posterior - avoid loading in flexion >45

**If pain or swelling occurs with any activities, they must be modified to decrease symptoms


14/21




Phone: (610) 527-2727

Fax: (610) 527-1588

MULTI-LIGAMENT RECONSTRUCTION



BEARING EXERCISES

PHASE I

0 - 3 weeks Non - weight Locked in f ull extension None Quad sets, ankle pumps, SLR, hip ab/

bearing adduction, hamstring/calf stretch, calf

press with theraband, patellar mobilization

3 - 6 weeks Non - weight 3 - 6 weeks: locked in full passive only** Add chair slides, passive ROM in prone

bearing extension for ambulation - to tolerance position

removed for exercise 0 to 70 degrees

PHASE II

6 - 12 weeks Weeks 6 - 10: 6-10 weeks: unlocked for Maintain full 6-8 weeks: gait training, wall slides,

Progress 25% per all act ivities extension and mini-squats, resisted hip exercises in

week until full 10 weeks - 4 mo:Varus progressive standing***

weight bearing at 10 unloader brace f lexion 8-12 weeks: stationary bike with light

weeks resistance (to begin) and seat higher

than normal, closed chain terminal kneeextensions, Stairmaster, balance and

propriception activities, leg press (limiting

knee flexion to 90 )

PHASE III

12 weeks - Full, without use Varus unloader brace Gain full and Advance closed chain strengthening,

4 months of crutches and pain-free progress proprioception and balance

with a normalized activities, maintain flexibility

gait pattern

4 mo - 7 mo Full None Full Treadmill walking, advance to jog

Add hamstring curls for strengthening

PHASE IV

7 months Full None Full and Maintain strength, endurance, and

and beyond pain-free function, begin sport-specific functional

progression (backward running, cutting,

grapevine, etc.), progress to running,

initiate a plyometric program

Return to sports with PCL brace until

1 year post-op

**Maintain anterior pressure on proximal tibia as knee is flexed - prevent posterior sagging at all times

***Resistance must be proximal to knee with hip ab/adduction exercises


15/21


Sports Medicine



Phone: (610) 527-2727

Fax: (610) 527-1588

OSTEOCHONDRAL AUTOGRAFT TRANSPLANT



BEARING EXERCISE

PHASE I Non-weight 0-1 week:locked in 0-6 weeks: PROM/AAROM to tolerance,

0 - 6 weeks bearing full extension (remove CPM: use for patella and t ibiof ibular joint mobsfor CPM and exercise) 6-8 hours (grades I & ll), stationary bike for ROM,

2-4 weeks: gradually per day - begin quad, hamstring, adduction, and gluteal

open brace in 20 in- at 0-50 , 1 sets, hamstring stretches, hip

crements as quad control cycle/minute - strengthening, SLR, ankle pumps

is gained - discontinue use increasing

of brace when quads can 5-10 daily per

control SLR without an patient comfort -

extension lag patient should

gain 100 by

week 6

PHASE II Progress to None Gradually Gait training, scar and patellar mobs,

6 - 8 weeks full weight increase flexion- quad/hamstring strengthening, begin

bearing patient should closed chain activities (wall sits, shuttle,

obtain 130 of mini-squats, toe raises), begin unilateral

f lexion stance activities

PHASE III Full with a None Full and Advance activities in phase II

8 - 12 weeks normalized pain-free

gait pattern


16/21


Sports Medicine



Phone: (610) 527-2727

Fax: (610) 527-1588

OSTEOCHONDRAL ALLOGRAFT TRANSPLANT



BEARING EXERCISE

PHASE I Non-weight 0-1 week:locked in 0-6 weeks: PROM/AAROM to tolerance, patella and

0 - 6 weeks bearing full extension (removed CPM: use for tibiof ibular joint mobs (grades I & II),for CPM and exercises) 6-8 hours per quad, hamstring, and gluteal sets,

2-4 weeks: Gradually day - begin at hamstring stretches, hip strengthening,

open brace in 20 in- at 0-40 - SLR

crements as quad control increasing 5-10

is gained - discontinue use daily per patient

of brace when quads can comfort

control SLR without an patient should

extension lag gain 100 by

week 6

PHASE II Partial weight None Gradually Scar and patellar mobs, quad/hamstring

6 - 8 weeks b earing (25%) increase flexion- strengthening, stationary bike for ROM,patient should continue to advance lower extremity

have 130 of strengthening activities

flexion

PHASE III Gradually return to None Progress to full Gait training, begin closed chain activities

8 - 12 weeks full weight bearing and pain-free (wall sits, shuttle, mini-squats, toe

raises), begin unilateral stance activities

PHASE IV Full with a None Full and Advance phase III activities

12 weeks - normalized pain-free

6 months gait pattern


17/21




Phone: (610) 527-2727

Fax: (610) 527-1588

PATELLAR REALIGNMENT W/ OSTEOTOMY

FOR PATELLAR INSTABILITY - REHABILITATION PROTOCOL

WEIGHT BRACE ROM** THERAPEUTIC

BEARING EXERCISES

PHASE I Non-weight bearing 0 - 2 weeks: Locked in 0 - 2 weeks: Heel slides, quad/hamstring sets,

0 - 6 weeks extension for sleep, 0 - 30 degrees patellar mobilization in all quadrants, prone

ambulation, can 2 - 4 weeks: hangs, gastroc/soleus stretch*,

unlock 0 - 30 degrees 0 - 60 degrees Straight leg raising with brace locked in

2 - 4 weeks:Unlocked 4 - 6 weeks: extension, edema control

0 - 60 degrees 0 - 90 degrees

4 - 6 weeks:Unlocked

0 - 90 degrees

PHASE II 6 - 8 weeks: 6 - 8 weeks:Unlocked Maintain full Progress to normal gait pattern,

6 - 12 weeks Advance to weight 8 weeks:Discontinue use extension and gastroc/soleus stretch, begin toe

bearing as tolerated progressive raises, closed chain extension,

Discontinue crutches flexion balance exercises, hamstring

as tolerated curls, and stationary bike


3 - 4 months of crutches and pain-free strengthening, progress

with a normalized proprioception activities, begin


running straight ahead


4 months and pain-free progression of function: forward/

beyond backward running, cutting, grapevine,



Gradual return to sports participation,

maintenance program for strength

and endurance

* This exercise is to be performed in a non-weight bearing position

** In cases of realignment for patellar cartilage defects, CPM & full motion may be allowed


18/21




Phone: (610) 527-2727

Fax: (610) 527-1588

PCL RECONSTRUCTIONREHABILITATION PROTOCOL


BEARING EXERCISES

PHASE I







PHASE II



week until full 10 weeks: discontinue use progressive standing***

weight bearing at 10 flexion 8-12 weeks: stationary bike with light


than normal, closed chain terminal knee

extensions, Stairmaster, balance and


knee flexion to 90 ), open chain quad

ranging from 0 - 60 degrees

PHASE III

12 weeks - Full, without use None Gain full and Advance closed chain strengthening,



gait pattern



PHASE IV






Return to sports in PCL brace until 1 year

post-op




19/21




Phone: (610) 527-2727

Fax: (610) 527-1588

PCL INJURY - NON-OPERATIVE



BEARING EXERCISES

PHASE I

0 - 1 weeks Progress to weight- Locked in full extension Within limits of Isometric quad sets, ankle pumps, SLR,

bearing as tolerated when not in PT pain, in prone hip ab/adduction, hamstring/calf stretch,

with crutches position No open chain hamstrings

2 - 3 weeks WBAT, Brace unlocked for f lexion Increase ROM, Add open chain knee extension

can discontinue 15 degree extension stop in prone position

crutches for ambulation

PHASE II

3 - 4 weeks W BAT Fit for PCL brace, 15 Full, begin Add closed chain exercises

degree extension stop active ROM stationary bike with light

resistance (to begin) and seat higher

than normal, closed chain terminal kneeextensions, Stairmaster, balance and


knee flexion to 90 ), open chain quad

ranging from 0 - 60 degrees

No open chain hamstrings

PHASE III

5 - 6 weeks Full, without use PCL brace for remainder Gain full and Advance closed chain strengthening,

of crutches and of season, extension stop pain-free progress proprioception and balance

with a normalized at zero activities, maintain flexibility

gait pattern May add hamstring strengthening


20/21




Phone: (610) 527-2727

Fax: (610) 527-1588

PCL and PLC RECONSTRUCTIONREHABILITATION PROTOCOL


BEARING EXERCISES

PHASE I







PHASE II



week until full 10 weeks - 4 mo:Varus progressive standing***

weight bearing at 10 unloader brace f lexion 8-12 weeks: stationary bike with light


than normal, closed chain terminal knee

extensions, Stairmaster, balance and


knee flexion to 90 )

PHASE III

12 weeks - Full, without use Varus unloader brace Gain full and Advance closed chain strengthening,



gait pattern



PHASE IV






Return to sports with PCL brace until

1 year post-op




21/21

knee rehabilitation - physical therapy protocols

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