Posterior Cruciate Ligament (PCL) Reconstruction with Achilles Allograft

Phase I (Weeks 0-4)

1. Weightbearing: As tolerated with crutches (may be modified if concomitant posterolateral corner reconstruction, meniscal repair / meniscal transplant or articular cartilage procedure is performed)
2. Hinged Knee Brace
   • Locked in full extension for ambulation and sleeping (Weeks 0–1)
   • Locked in full extension for ambulation – removed for therapy sessions (Weeks 1–4)
3. Range of Motion
   • Weeks 0–1: None
   • Weeks 1–2: PROM 0–30°
   • Weeks 2–4: PROM 0–90°
   • MAINTAIN ANTERIOR PRESSURE ON PROXIMAL TIBIA AS KNEE IS FLEXED FROM WEEK 1–4 — PREVENT POSTERIOR SAGGING AT ALL TIMES
4. Therapeutic Exercises
   • Quad / Hamstring sets and ankle pumps
   • Straight-leg raise with brace in full extension until quad strength prevents extension lag
   • Hip abduction / adduction – for hip pain
   • Hamstring / Calf stretch – calf press with theraband progressing to standing toe raises with knee in full extension

Phase II (Weeks 4-12)

1. Weightbearing: As tolerated with crutches – discontinue crutch use at 6–8 weeks post-op
2. Hinged Knee Brace
   • Weeks 4–6: Unlocked for gait training / exercise only
   • Weeks 6–8: Unlocked for all activities
   • Discontinue brace at 8 weeks post-op
3. Range of Motion – Maintain full knee extension; work on progressive knee flexion (goal of 110° by week 6)
4. Therapeutic Exercises
   • Weeks 4–8: Gait training, wall slides (0–30°), mini-squats (0–30°), leg press (0–60°)
   • Weeks 8–12: Stationary bicycle (seat higher than normal), Stairmaster, closed-chain terminal knee extension, leg press (0–90°), balance and proprioception activities

Phase III (Weeks 12–9 Months)

1. Weightbearing: Full weightbearing with normalized gait pattern
2. Range of Motion – Full / painless ROM
3. Therapeutic Exercises
   • Advance closed chain strengthening exercises
   • Progress with proprioception / balance activities
   • Maintain flexibility
   • Begin treadmill walking – progress to jogging

Phase IV (9 Months and Beyond)

1. Therapeutic Focus
   • Maintain strength, endurance and function – initiate plyometric program
   • Begin cutting exercises and sport-specific drills
   • Return to sports as tolerated

Comments

• AVOID ACTIVE HAMSTRING ACTIVITY AND ACTIVE KNEE EXTENSION FROM 90–70° UNTIL POST-OP WEEK 4