Intended for licensed physical therapists coordinating care with Dr. Vasileff. Defer to the operative note and the surgeon’s office for patient-specific direction.
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Knee · Ligament

PCL Reconstruction

Post-operative protocol · Dr. Chris Vasileff, MD
For the treating physical therapist. This protocol is a guideline; progression is criteria-based and individualized. Defer to the operative note and the surgeon’s office for patient-specific direction.

Phase I – Maximum Protection (Weeks 0 to 6):

Weeks 0 to 6:

  • Brace at all times locked at 0°/0° for six to eight weeks
  • Ice and modalities to reduce pain and inflammation
  • Use crutches PWB for 6 weeks

Range of Motion

- Begin aggressive patella mobility

- Limit ROM 0°-90° with passive prone flexion or seated with anterior tibial translation by the patient or therapist for first 6 weeks

Exercises

- Quadriceps setting; towel placed behind tibia. Focusing on VMO contraction

- Blood Flow Restriction Therapy for muscle mass and quad activation

- Straight leg raises in the brace

Phase II – Progressive Stretching and Early Strengthening (Weeks 6 to 12):

Weeks 6 to 12:

  • Continue with modalities to control inflammation
  • Open brace 0°-90° if patient demonstrates good quadriceps function

Range of Motion

- Progress to full knee ROM. Minimize posterior tibial translation

Exercises

- May begin active hamstring contractions

- Begin total leg strengthening with SLR program (no resisted hamstrings x 12 wks)

- Bilateral closed kinetic chain squatting

- Multi-plane open and closed kinetic chain hip strengthening

- Unilateral step-up progression

- Stationary biking

- Pool program; walking and deep water exercise only. No running

- Proprioception drills

Phase III – Advanced Strengthening and Proprioception Phase (Weeks 12 to 24):

Weeks 12 to 24:

Range of Motion

- Full

Exercises

- Advance cardiovascular program; stationary bike, treadmill walking, elliptical trainer

- Increase intensity of closed kinetic chain exercises

- May begin resisted hamstring exercises

- Advance proprioception drills

- Initiate gym strengthening progressing from bilateral to unilateral as tolerated:

- Leg press, squats, partial lunges, hamstring curls, ab/adduction, calf raises

Phase IV – Advance Strengthening and Return to Sport (Weeks 20 to 9mo/12mo):

  • Pool running at 20 weeks
  • Dry land running at 24 weeks
  • Multidirectional agility drills at 7-8 months
  • Return to sport 9-12 months
Questions about a protocol? Contact Dr. Vasileff’s office at (704) 865-0077.