Posterior Cruciate Ligament (PCL) Reconstruction with Achilles Allograft

Phase I (Weeks 0-4)

1. Weightbearing:  As tolerated with crutches (may be modified if concomitant posterolateral corner reconstruction, meniscal repair/meniscal transplant or articular cartilage procedure is performed)
2. Hinged Knee Brace: Locked in full extension for ambulation and sleeping (Weeks 0-1)Locked in full extension for ambulation – removed for therapy sessions (Weeks 1-4)
3. Locked in full extension for ambulation and sleeping (Weeks 0-1)
4. Locked in full extension for ambulation – removed for therapy sessions (Weeks 1-4)
5. Range of Motion – Weeks 0-1: None, Weeks 1-2: PROM 0-30°, Weeks 2-4: PROM 0-90° (MAINTAIN ANTERIOR PRESSURE ON PROXIMAL TIBIA AS KNEE IS FLEXED FROM WEEK 1-4—NEED TO PREVENT POSTERIOR SAGGING AT ALL TIMES)
6. Therapeutic ExercisesQuad/Hamstring sets and ankle pumpsStraight-Leg Raise with brace in full extension until quad strength prevents extension lagHip abduction/adduction – for hip painHamstring/Calf stretch – Calf press with theraband progressing to standing toe raises with knee in full extension 
7. Quad/Hamstring sets and ankle pumps
8. Straight-Leg Raise with brace in full extension until quad strength prevents extension lag
9. Hip abduction/adduction – for hip pain
10. Hamstring/Calf stretch – Calf press with theraband progressing to standing toe raises with knee in full extension 

Phase II (Weeks 4-12)

1. Weightbearing:  As tolerated with crutches– discontinue crutch use at 6-8 weeks post-op
2. Hinged Knee Brace:  Weeks 4-6: unlocked for gait training/exercise only, Weeks 6-8: unlocked for all activities, Discontinue brace at 8 weeks post-op
3. Range of Motion–Maintain full knee extension–work on progressive knee flexion (Goal of 110° by week 6)
4. Therapeutic ExercisesWeeks 4-8:  Gait training, wall slides (0-30°), Mini-squats (0-30°), Leg press (0-60°)Weeks 8-12:  Stationary bicycle (with seat higher than normal), Stairmaster, Closed-chain terminal knee extension, Leg press (0-90°), Balance and proprioception activities
5. Weeks 4-8:  Gait training, wall slides (0-30°), Mini-squats (0-30°), Leg press (0-60°)
6. Weeks 8-12:  Stationary bicycle (with seat higher than normal), Stairmaster, Closed-chain terminal knee extension, Leg press (0-90°), Balance and proprioception activities

 Phase III (Weeks 12-9 months)

1. Weightbearing:  Full weightbearing with normalized gait pattern
2. Range of Motion – Full/Painless ROM
3. Therapeutic ExercisesAdvance closed chain strengthening exercises, progress with proprioception/balance activitiesMaintain flexibilityBegin treadmill walking – progress to jogging
4. Advance closed chain strengthening exercises, progress with proprioception/balance activities
5. Maintain flexibility
6. Begin treadmill walking – progress to jogging

 Phase IV (9 months and beyond)

1. Maintain strength, endurance and function – initiate plyometric programBegin cutting exercises and sport-specific drillsReturn to sports as tolerated
2. Maintain strength, endurance and function – initiate plyometric program
3. Begin cutting exercises and sport-specific drills
4. Return to sports as tolerated

Comments:  AVOID ACTIVE HAMSTRING ACTIVITY AND ACTIVE KNEE EXTENSION FROM 90-70° UNTIL POST-OP WEEK 4