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

Posterolateral Corner (PLC) 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.

Posterolateral Corner Rehabilitation Protocol

****NO VARUS STRESS, EVER***

Phase I – Maximum Protection (Weeks 0 to 2):

0 to 1 Week:

  • Brace at all times when not exercising, for six weeks
  • Brace 0/0 for six weeks.
  • Ice and modalities to reduce pain and inflammation
  • Use crutches weight bearing as tolerated for 7 to 10 days to reduce swelling. The patient may discontinue the crutches when they can ambulate with no limp

Range of Motion

- Begin aggressive patellar mobility

- Don’t emphasize hyperextension for 6 weeks; can work on extension

- 0° - 60° - No varus stress **EVER**.

Exercises

- Quadriceps setting, focusing on VMO

- Blood Flow Restriction therapy for muscle mass and quad activation

- Multi-plane straight leg raising

- Gait training

Weeks 1 to 2:

  • Continue with program outlined above

Range of Motion

- Still 0° - 60° of knee flexion

Phase II – Progressive Stretching and Early Strengthening (Weeks 2 to 6):

Weeks 2 to 4:

  • Continue with modalities to control inflammation

Range of Motion

- Progress knee flexion to 90°

Exercises

- Continue with phase I exercise

- Bilateral closed kinetic chain squatting, to 30° of knee bend from standing

- Multi-plane open and closed kinetic chain hip strengthening

- Step-up progression

- Pool program when incisions healed; focus on ROM

Weeks 4 to 6:

Range of Motion

- 0° – 90° – Slowly advance as tolerated to 120°

Exercises

- Advance strengthening program progressing to unilateral as tolerated

- Start stationary bike program

- Proprioception drills

- Advance intensity of pool program; focus on strengthening

Phase III – Advanced Strengthening and Proprioception Phase (Weeks 6 to 12):

Weeks 6 to 12:

Range of Motion

- Full knee flexion and extension with some terminal stretch

Exercises

- Advance cardiovascular program; no running

- Increase intensity of closed kinetic chain exercises

- Add proprioception drills

- Initiate gym strengthening progressing from bilateral to unilateral as tolerated

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

- Begin multi-directional functional cord work; no carioca

Weeks 10 to 12:

  • May begin a pool/walking to running program

Phase IV – Advance Strengthening and Plyometric Drill Phase (Weeks 12 to 16):

Weeks 12 to 16:

  • Implement a full gym strengthening program; including leg extensions at 30° - 0°, progressing to full range as PF arthrokinematics normalize
  • Begin straight plane running
  • Begin non-aggressive plyometric drills, keeping foot contacts < 100

Phase V – Return to Sport and Functional Drills Phase (Weeks 16 to 24):

Weeks 16 to 20:

  • Continue with aggressive lower extremity strengthening, cardiovascular training, and flexibility
  • Implement sport specific drills
  • Advance plyometric drills from bilateral to unilateral as tolerated

Weeks 20 to 24:

  • Follow-up examination with the physician
  • Brace fitting for functional knee brace
  • Sports test for return to competition

RETURN TO ACTIVITIES

Running: 4-5 months when functional criteria are met

Golf: Short irons at 4 months, full swing with long irons at 5 months.

Delay 4-6 weeks if lead leg.

Pivoting/cutting sport: When functional criteria are met and cleared by surgeon, typically

6+ months at earliest

Questions about a protocol? Contact Dr. Vasileff’s office at (704) 865-0077.