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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