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Rehabilitation protocol after posterolateral corner surgery - overview
Submitted by admin on September 30, 2009 - 10:11pm.
Rehabilitation following posterolateral knee reconstruction follows specific protocols depending on the phase of rehabilitation.
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Part 7 of a course by Dr Frank Noyes on Posterolateral corner injuries of the knee
Rehabilitation following posterolateral knee reconstruction follows specific protocols depending on the phase of rehabilitation.
Below I have given you an overview of our own rehabilitation protocol phase by phase, and on the right you will be able to click through to the detailed protocols for each phase.
Overview
| 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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