Time frames for brace or crutches may be extended by dr. The acl prevents the lower bone tibia from sliding forward. Rehabilitation following surgery for posterior cruciate ligament pcl injury is an essential element of the treatment to achieve a full recovery. Change dressing, keep wound covered, continue ted hose pod 710.
It is often difficult to predict the longterm outcome of a pcl injury. The therapist must watch for patellar pain due to the increased tibial drop back present with a ruptured pcl. Posterior cruciate ligament pcl reconstruction phase i weeks 04 weightbearing. Rehabilitation guidelines for posterior cruciate ligament. Lowe this rehabilitation protocol has been developed for the patient who has posterior cruciate ligament pcl reconstruction using a secure graft with internal fixation.
Injury to the pcl can often be managed with nonoperative treatment. The goal of pcl surgery is to restore normal knee stability and return to. Surgical reconstruction is done by replacing the torn pcl with a graft. No resisted knee flexion exercises for 4 weeks postop. Early activity following pcl repair can lead to increased laxity. Rehabilitation after pcl reconstruction plays a major role in obtaining a functional result. Nonsurgical treatment patients should meet the criteria for isolated pcl injury table 1. Rehabilitation guidelines for posterior cruciate ligament reconstruction. This is the initial recovery phase and it normally lasts 1 3 weeks. Acl patient information acl preoperative protocol acl reconstruction rehab protocol arthrosurface joint replacement protocol high tibial osteotomy iliotibial band tendinitis knee arthroscopy protocol knee scope chart knee sports conditioning knee strength training maci rehabilitation mcl. Regular manual care of the patella, patella tendon, and portals should be performed to prevent fibrosis. Knee pcl reconstruction rehabilitation program gundersen. Chapter 41 posterior cruciate ligament reconstruction 479 midstance phase of gait. Driving is often resumed after the first week or two and when all pain medicationsnarcotics are no longer needed.
As tolerated with crutches may be modified if concomitant posterolateral corner reconstruction, meniscal repairmeniscal transplant or articular cartilage procedure is performed. The intent of this protocol is to provide the clinician with a guideline for the post operative rehabilitation course of a patient that has undergone a pcl or pcl acl reconstruction. Brace knee immobilizer or fracture brace is used 24 to 48 hours after surgery. This rehabilitation protocol has been developed for the patient who has posterior cruciate ligament pcl reconstruction using a secure graft with internal fixation. The following is a protocol for postoperative patients following pcl reconstruction. Operative pcl rehabilitation protocol this protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. Posterior cruciate ligament reconstruction rehabilitation protocol dr. Medial collateral ligament and mpfl repair rehabilitation protocol. Range of motion exercises are initiated at the surgeons discretion in the initial six weeks postoperatively. Pdf posterior cruciate ligament pcl is a major stabilizer of the knee joint. Grafts can be taken from areas of your own body autograft, such as the patellar tendon, or from cadavers allograft. 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 by no means intended to be a substitute for ones clinical decision making regarding the progression. Frequent use of cryocuff andor ice with lower extremity elevated.
Pcl rehab sports medicine orthopedic surgeon houston, tx. Chattanooga, tn 423 6242696 this protocol is a guideline for your rehabilitation after posterior cruciate ligament reconstruction. Roidis nikolaos, md, phd, dsc senior consultant orthopaedic surgeon 3rd orthopaedic department kat hospital pcl reconstruction postsurgical rehabilitation protocol postop days 1 14. This can be removed once the femoral nerve block has worn off and an independent straight leg raise is achieved. This graft can be a single strandbundle of tissue or two strands double bundle. The pcl reconstruction rehabilitation is unique in that extreme knee flexion places a higher amount of stress on the newly reconstructed pcl. Medial collateral ligament and mpfl repair rehabilitation. If there is a combined reconstruction involving both the pcl and the acl, then rehabilitation will progress according to the isolated pcl protocol.
Proper rehabilitation after pcl surgery is essential to success. Posterior cruciate ligament pcl reconstruction rehabilitation protocol the following is a protocol for postoperative patients following pcl reconstruction. Pcl nonoperative rehabilitation protocol page 1 of 3 bart eastwood d. Rehabilitation following pcl reconstruction postoperative phase i. Pcl acl and 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 pcl acl reconstruction. This protocol is intended to provide the user with instruction, direction, rehabilitative guidelines and functional goals. Unlocked for ambulation, remove for sleeping as tolerated quad sets, patellar mobs, gas trocsoleu s etch slr w brace in full extension. 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. Sutures out, dc ted hose when effusion resolved brace x 3 months locked in extension x 8 weeks.
Materials and methods a systematic search of the literature was conducted. Current concepts and controversies brian forsythe, md department of orthopaedic surgery rush university medical center midwest orthopaedics at rush chicago, il usa hot topics in pcl reconstruction 1. Surgical reconstruction of a torn acl involves replacing the torn. It is designed for rehabilitation following a pcl injurytear, typically grade i and ii. Begin patellar mobilizations 10 reps each direction tid. 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.
We have remained at the forefront of medicine by fostering a culture of collaboration, pushing the boundaries of medical research, educating the brightest medical minds and maintaining an unwavering commitment to the diverse communities we serve. Acl reconstruction protocol1 northwestern medical center. 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. Driving is permitted once your leg is strong and coordinated to react safely to avoid an accident. Pcl andor posterolateral corner reconstruction overview.
The combination of search terms utilized were posterior cruciate ligament reconstruction or pcl and rehabilitation or physical therapy. 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. 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. For many aspects of acl rehabilitation there are either no studies that qualify as bestevidence or the number of. Associate professor of orthopaedics chief division of sports medicine tel. Posterior cruciate ligament reconstruction brett sanders, md center for sports medicine and orthopaedic 2415 mccallie ave. Edema control continue edema control until edema resolves typically 4 weeks or less. Begin the first 3 exercises below and add others gradually as tolerated. Mcl injury restrict motion to sagittal plane until week 46 to allow healing of mcl. Rehabilitation program for posterior cruciate ligament pcl andor multiligament reconstruction october 2018 this protocol is designed to assist you with your rehabilitation after surgery and should be followed under the direction of a physiotherapist. Begin scar massage after incision site sloughsscar is formed. Posterior cruciate ligament rehabilitation protocol. Roidis nikolaos, md, phd, dsc senior consultant orthopaedic surgeon 3rd orthopaedic department kat hospital pcl reconstruction postsurgical rehabilitation protocol. Posterior cruciate ligament pcl reconstruction rehabilitation program introduction the posterior cruciate ligament pcl is the strongest ligament in the knee.
The pcl reconstruction rehabilitation is unique in that extreme knee flexion places a higher. In particular, we intended to perform categorical analysis and discuss some critical points. It is important to understand that all time frames are approximate and that progressions should be based on individual monitoring. Gallandkirby pcl reconstruction postsurgical rehabilitation protocol postop days 1 14 dressing.
No open chain hamstring strengthening or isolated hamstring exercises. Additionally, a small, nondisplaced pcl bony avulsion with grade iii laxity can also reportedly be treated with progressive weight. It contains detailed exercises appropriate for the different phases of rehabilitation. Apply tdcs rehabilitation protocols to post stroke and. Arthrex provides a comprehensive line of pcl reconstruction instrumentation options for a variety of pcl reconstruction techniques. Posterior cruciate ligament reconstruction rehabilitation. Madison, wi 53718 rehabilitation guidelines for posterior cruciate ligament reconstruction the knee has three jointsthe patellofemoral joint knee cap, the tibiofemoral joint and the tibiofibular joint. Postoperative rehabilitation after posterior cruciate. The primary goal of this protocol is to protect the reconstruction while steadily progressing towards and ultimately achieving preinjury level of activity. Posterior cruciate ligament pcl reconstruction rehabilitation. The path to regaining range of motion, strength and function can require a sustained and coordinated effort from the patient, his or her family, the ohio state sports medicine physical therapy team and sometimes, other healthcare providers. The exercises will help to strengthen the muscles around the knee and help you to regain full range of movement. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury level of activity. Loss of knee extension has been shown to result in a limp, quadriceps muscle weakness, and anterior knee pain.
Consider brace for exercise and periods of activity if severe sprain andor patient has pain. Days 1 to seven moderate to severe calf pain should be reported immediately. Nov 08, 2012 acl reconstruction rehabilitation protocol peter j. The intent of this protocol is to provide the clinician with a guideline for a nonoperative rehabilitation course of a patient with an isolated posterior cruciate ligament injury. Acl reconstruction postoperative rehabilitation protocol. Posterior cruciate ligament rehabilitation tends to follow slower rehabilitation protocols than those for acl injuries. It is by no means intended to be a substitute for ones clinical decision making regarding the progression of a. Pcl reconstruction with the acufex director drill guide. Madison, wi 53718 rehabilitation guidelines for knee multiligament repair reconstruction the knee joint is comprised of an articulation of three bones. A comprehensive search of pubmed, embase and cochrane internet databases was performed in order to identify relevant articles. Rehabilitation protocols ohio state sports medicine. Millett, md, msc steadman hawkins clinic vail, colorado slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Pcl and posterolateral corner rehab protocol the pcl reconstruction fixation is not as sturdy as a typical acl fixation, so prevention of posterior tibia translation through the first eight weeks is paramount.
Also, surgical leg and type of car are considered before being cleared to drive. Mpfl reconstruction rehabilitation the following is a protocol for postoperative patients following medial patellofemoral ligament reconstruction. Goals are to increase strength, power and cardiovascular conditioning. Postoperative rehabilitation after posterior cruciate ligament reconstruction and combined posterior cruciate ligament. Mack follows four stages, and begins within 17 days of. This article illustrates gregory fanelli, mds surgical technique for the arthroscopic singlebundle, singlefemoral tunnel and doublebundle, doublefemoral tunnel transtibial pcl reconstructions. Acl reconstruction rehabilitation protocol one of the most common complications following acl reconstruction is loss of motion, especially loss of extension. Cole,md,mba weight bearing brace rom exercises phase i 04 weeks full in brace 01 week. If wound is dry may leave open and cover with compressive sleeve. 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. It is by no means intended to be a substitute for ones clinical decision. Rehabilitation guidelines for knee multiligament repair. 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.
New investigations into pcl rehabilitation protocols could potentially help to improve outcomes following pcl reconstruction and nonoperative rehabilitation. Sports medicine physical therapy rehabilitation protocols. Pcl reconstruction rehabilitation protocol dr david mack. 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. You may vary in your ability to do these exercises and to. 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. Mack follows four stages, and begins within 17 days of surgery. Electrodes placed over proximal lateral quadriceps and. Wulf, md posterior cruciate ligament reconstruction.
Full knee romall rom exercises must be performed in the prone or side lying position for the first month 45 weeks. Pcl non operative rehabilitation guideline this rehabilitation program is designed to return the individual to their activities as quickly and safely as possible. The therapist must also be aware that the lateral structures of the knee act as secondary stabilizers to posterior translation and need to be guarded initially. Nhs trust acl reconstruction physiotherapy advice for. Pcl reconstruction with or without pl repair reconstruction secondary surgery possible. The intent of this protocol is to provide the clinician with a guideline for. Pdf rehabilitation after posterior cruciate ligament reconstruction.
It is by no means intended to be a substitute for ones clinical decisionmaking regarding the progression of. Posteri or cr uc i ate l i game nt re c onstr uc ti on. Posterior cruciate ligament reconstruction uw health. Locked in ful extensi on r ambulation and sleeping 14 weeks. Fit for functional pcl brace to be used for sporting activities and more ballistic rehabilitation training.
274 1602 1327 1346 32 820 844 499 55 1210 1155 1332 1358 1494 1505 1161 347 16 1038 794 865 220 607 1234 601 1230 1446 579 660 468 641 110 955