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

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.