Isolated PCL Injury
Rehabilitation – conservative treatment
| PHASE I WEEK 1-2 |
PHASE II WEEK 3-6 |
PHASE III WEEK 7-12 |
PHASE IV > MONTH 3 |
|
|---|---|---|---|---|
| Weight Bearing | PWB (20% flat foot) Symptomatic control |
WBAT | WBAT | FWB |
| Brace | Rebound PCL Day & night (within 4 weeks of Injury) grey shear knob |
Rebound PCL (day & night; grey shear knob) | Rebound PCL (day & night) use white shear knob > week 10 | Rebound PCL 4 months daily; + during RTP up to 6 months |
| ROM Limitation | Up to 0-0-90° (with brace) work on full extension | 0-0-90° with brace | None | None |
| Physical Therapy | Do: Quad activation, edema control, closed chain, prone flexion 90°
Don’t: active flexion, hamstring activation |
Do: Quads activation, edema control, closed chain, prone flexion, stationary biking with low resistance – (no toe clips)
Don’t: perform isolated hamstrings |
Do: Increase resistance, agility and proprioception
Don’t: isolated hamstrings without brace, cycling with toe clips |
Do: progress to full training. Ideally RTP month 4-6
Don’t: RTP without specific training |
| Other | (kneeling) PCL stress x-rays if tolerated
Follow DVT prevention guidelines |
Follow DVT prevention guidelines | Follow DVT prevention guidelines | kneeling PCL stress x-rays |
| Recommendation for grade I PCL injuries: Use Rebound PCL only in case of professional sports athletes. | ||||
Abbreviations: PWB: partial weight bearing, WBAT, Weight bearing as tolerated, FWB, Full weight bearing, RTP: Return to play
Isolated Or Combined PCL Injuries
Rehabilitation – following surgical reconstruction
| PHASE I WEEK 1-2 |
PHASE II WEEK 3-6 |
PHASE III WEEK 7-12 |
PHASE IV > MONTH 3 |
|
|---|---|---|---|---|
| Weight Bearing | NWB | NWB / PWB (20%)(No PWB in case of varus knee) | WBAT slower transition in case of small (auto-) graft size | FWB |
| Brace | Extension lock: a) Immobilizer (in case of PWB and / or swelling) or b) Rebound PCL day & night (grey shear knob) |
Rebound PCL (day & night); use grey shear knob – also in case of combined PCL & ACLinjury | Rebound PCL (day & night); use white shear knob > week 10 – also in case of combined PCL & ACL injury | Rebound PCL during day for +1 month, or activity, or ADL‘s w/ deep flex, wean off > month 6. Continue to wear for next sports season |
| ROM Limitation | 0-0-90 prone / assisted | For NWB: 0-0-90 (with R PCL) For PWB: Extension locked |
None Slower progression to full ROM in case of small (auto-) graft size |
None |
| Physical Therapy | Do: Quad Activation, edema control, closed chain, prone flexion Don’t: active flexion, hamstring activation |
Do: Activation, edema control, closed chain, prone flexion, biking low resistance (no toe clips) Be careful Don’t: perform hamstring activation, open chain |
Do: Increase resistance, agility and proprioceptive training Slow down the rehab in case of flat tibial slope Don’t: Open chain hamstrings, contact sport |
Do: Progress to general strengthening, eliptical training & biking resistance as tolerated. > month 6 progress to full training RTP month 9-12 after sport specific testing |
| Other | Follow DVT prevention guidelines | Follow DVT prevention guidelines | Follow DVT prevention guidelines | Month 6: kneeling PCL stress x-rays |
Abbreviations: PWB: partial weight bearing, WBAT, Weight bearing as tolerated, FWB, Full weight bearing, RTP: Return to play
Phase I – Maximum Protection (Weeks 0 to 6):
Weeks 0 to 6:
-
- Brace at all times locked at 0°/0° for six to eight weeks
- Ice and modalities to reduce pain and inflammation
- Use crutches PWB for 6 weeks
Range of Motion
-
-
- Begin aggressive patella mobility
- Limit ROM 0-90 with passive prone flexion or seated with anterior tibial translation by the patient or therapist for first 6 weeks
-
Exercises
-
- Quadriceps setting; towel placed behind tibia. Focusing on VMO contraction
- Straight leg raises in the brace
Phase II – Progressive Stretching and Early Strengthening (Weeks 6 to 12):
- Continue with modalities to control inflammation
- Open brace 0°-90° if patient demonstrates good quadriceps function
- Range of Motion
- Progress to full knee ROM. Minimize posterior tibial translation
- Exercises
- May begin active hamstring contractions
- Begin total leg strengthening with SLR program (no resisted hamstrings x 12 wks)
- Bilateral closed kinetic chain squatting
- Multi-plane open and closed kinetic chain hip strengthening
- Unilateral step-up progression
- Stationary biking
- Pool program; walking and deep water exercise only. No running
- Proprioception drills
- Range of Motion
Phase III – Advanced Strengthening and Proprioception Phase (Weeks 12 to 24):
Weeks 12 to 24:
- Range of Motion
- Full
- Exercises
- Advance cardiovascular program; stationary bike, treadmill walking, elliptical trainer
- Increase intensity of closed kinetic chain exercises
- May begin resisted hamstring exercises
- Advance proprioception drills
- Initiate gym strengthening progressing from bilateral to unilateral as tolerated
- Leg press, squats, partial lunges, hamstring curls, ab/adduction, calf raises
Phase IV – Advance Strengthening and Return to Sport (Weeks 20 to 9mo/12mo):
- Pool running at 20 weeks
- Dry land running at 24 weeks
- Multidirectional agility drills at 7-8 months
- Return to sport 9-12 months
