Rehabilitation protocol after posterolateral corner surgery

An overview of the entire rehabilitation process after posterolateral corner surgery.

First published 2009 by Dr Frank R Noyes, and reviewed August 2023 by Dr Sheila Strover (Clinical Editor)

 

Overview of our own rehabilitation protocol phase by phase

Rehabilitation following posterolateral knee reconstruction follows specific protocols depending on the phase of rehabilitation.

 

postop weeks /months   1-2 wks 3-4 wks 5-6 wks 7-8 wks 9-12 wks 4 mths 5 mths 6 mths 7-12 mths
Brace Bivalved cylinder cast X X              
  Custom medial unloader

or hinged soft tissue brace		     X X X X X X X
Range of motion minimum goals 0-90 degrees X X              
  0-110 degrees     X            
  0-120 degrees       X          
  0-130 degrees         X        
Weight-bearing None X                
  Toe-touch - 25% body weight   X              
  25% - 50% body weight     X            
  Full, cane support       X          
  Full         X        
Patella mobilization   X X X X          
Modalities Electrical muscle stimulation X X X X          
  Pain/edema management (cryotherapy) X X X X X X X X X
Stretching Hamstring, gastroc-soleus, iliotibial band, quadriceps X X X X X X X X X
Strengthening Quad isometrics, straight leg raises  X  X  X X X        
  Active knee extension X X X X X        
  Closed-chain: gait retraining, toe raises,

wall site, mini-squats		 X X X X X X X X  
  Knee flexion hamstring curls (90 degrees)         X X X X X
  Knee extension quads (90-30 degrees)     X X X X X X X
  Hip abduction-adduction, multi-hip         X X X X X
  Leg press (70-10 degrees)         X X X X X
Balance /proprioceptive

training		 Weight-shifting, cup walking, BBS        X X        
  BBS, BAPS, perturbation training, balance board, mini-trampoline           X X X X
Conditioning UBC   X X X          
  Bike (stationary)     X X X X X X X
  Aquatic program         X X X X X
  Swimming (kicking)         X X X X X
  Walking           X X X X
  Stair climbing machine         X X X X X
  Ski machine           X X X X
Running: straight                   X
Cutting: lateral carioca, figure 8's                   X
Plyometric training                   X
Full sports                   X

BAPS = Biomechanical Ankle Platform System (Camp, Jackson, MI), BBS = Biodex Balance System (Biodex Medical Systems, Inc, Shirley, NY), UBC = upper body cycle (Biodex Medical Systems, Inc, Shirley, NY).

From Noyes FR, Barber-Westin SD, Heckmann TP: Rehabilitation of Posterior Cruciate Ligament and Posterolateral Reconstructive Procedures. In Noyes’ Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes. Noyes FR, Barber-Westin SD (eds.), Saunders, Philadelphia, 2009, pp. 631-657.

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Author

Dr Frank R Noyes

Retired knee surgeon

DR NOYES HAS RETIRED.


Based at the Cincinnati Sportsmedicine and Orthopaedic Center in the USA, Dr Frank Noyes is one of the world's most prominent figures when it comes to knee surgery. A prolific researcher and writer, he has published over 200 studies and articles in the world's top...read more

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