his protocol is intended to be a general outline only. The physician reserves the right to either advance or delay this protocol as deemed necessary. If so, this should be done by direct communication with the therapist, or in writing on the therapy referral form given to the patient on the day of surgery.
General Guidelines

  • Physical Therapy will begin immediately post-operatively and will continue 3-6 months.
  • HEP will be performed as instructed by Physical Therapist beginning with one pre-op appointment.
  • PCL to be protected for the first 12 weeks, with posterior tibial translation to be restricted during this time.  Addition of ACL reconstruction does not change the time frame of the PCL protocol.
  • At 12 weeks, solid graft to bone healing time should occur.
  • Weightbearing status: If isolated PCL injury, TTWB may begin 4 weeks post-op and advance gradually to FWB by 6 weeks.
  • With addition of LCL or posterolateral corner reconstruction, the patient should maintain NWB for 8 weeks. May progress to TTWB at 8 weeks, then progress gradually to FWB as tolerated.
  • Therapist should avoid all varus stress.
  • TROM must remain on and locked in extension for all ADL’s for first 8 weeks, including sleeping. With left leg involvement, driving can occur anytime patient is comfortable. With right leg involvement, driving may begin around 6-8 weeks with the ability to demonstrate good quadriceps control.

TROM Brace Guidelines:

  • PCL reconstruction only – locked in extension for 4 weeks, NWB. Progress to FWB by 6 weeks. Brace may be unlocked at 8 weeks post-operatively once good quad control can be demonstrated.
  • PCL with posterolateral component – locked in extension for 6 weeks, NWB. TTWB at 6 weeks, then progress to FWB at 8 weeks. Brace may be unlocked at 8 weeks once good quad control can be demonstrated.
  • TROM brace may be unlocked at 2 weeks for range of motion in PT clinic from 0-45 degrees. Increase to 60 degrees by 4 weeks. ROM exercises should be reviewed with patient to emphasize passive knee flexion and active knee extension to prevent tibial translation.

Day One Post-Op

  • Post-Surgical Appointment – perform dressing change, wound care instructions (change waterproof dressings and steristrips as needed at home and in clinic).
  • Protect healing of graft.
  • Prevent posterior tibial sagging (may place pillow under proximal tibia at rest to prevent posterior tibial translation).
  • Avoid patellofemoral joint compression and posterior tibial sagging.
  • Educate patient in clear understanding of post-op restrictions and expectations for the rehabilitation protocol.

Weeks 0-2: Pt. to be seen 2x/week or as needed throughout rehab.

  • TROM locked in extension
  • Open-chain hip extension, abduction, adduction
  • SLR performed in TROM brace
  • Ankle elastic band exercises

Weeks 2-4

  • Unlock TROM brace for range of motion work 0-45 degrees
  • Continue above exercises

Weeks 4-6
At 4 weeks, PCL-only reconstructions can begin TTWB and advance to FWB by 6 weeks. TROM can be unlocked or discontinued at 8 weeks post-op if patient has good quad control.

  • Continue with range of mo