Dr. Anthony A. Schepsis

Coastal Orthopedics
Beverly, MA
Professor of Orthopedic Surgery
Boston University School of Medicine

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schepsis@comcast.net

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PCL Surgery



Patient:

DOS:                                                                                  Anthony A. Schepsis, M.D.

Coastal Orthopedics

Beverly-Lahey Health

978-927-3040978-927-3040

REHABILITATION PROTOCOL: PCL RECONSTRUCTION

I.               IMMEDIATE POST OP WEEK ONE TO FOUR

GOALS: CONTROL SWELLING

 OBTAIN FULL PASSIVE EXTENSION

 GRADUALLY INCREASE FLEXION UP TO 90 DEGREES

 VOLUNTARY QUADRICEPS CONTOL

 PATELLAR MOBILITY

IMPORTANT FACT:  PREVENTION OF POSTERIOR SAG AND HAMSTRING ACTIVITY IS PARMOUNT IN AVOIDING RESIDUAL LAXITY

1. BRACE LOCKED AT ZERO DEGREES EXTENSION, SLEEP IN BRACE

2. WEIGHT BEARING- NO WEIGHT ON LEG FOR _________ WEEKS

3.  PILLOW UNDER PROXIMAL POSTERIOR TIBIA AT REST TO PREVENT POSTERIOR SAG

4. MOTION: OUT OF BRACE CPM INSTRUCTIONS:  GRADUAL, SLOW SPEED, ZERO TO 40 DEGREES, INCREASE 5 – 10 DEGREES DAILY.  GOAL: MAX OF 90 DEGREES.  USE FOR 2 HOUR SESSIONS THREE TIMES PER DAY

___________________________________________________________________________________________________________________________

5. EXERCISES:    PATELLAR MODILIZATION

                  STRETCH HAMSTRING AND CALF

                  ANKLE PUMPS

                  QUAD SETS

                  STRAIGHT LEG RAISES (3 WAY) HIP FL, ABD, ADD

                  KNEE EXTENSION 60-0 DEGREES

  1. MUSCLE STIM- TO QUADS AND BIOFEEDBACK
  2. PROTECTION PHASE (WEEK 4-6)

GOALS:  CONTROL EXTERNAL FORCES/PROTECT GRAFT

            RESTORE MOTION

            NOURISH ARTICULAR CARTILAGE

            DECREASE SWELLING

            DECREASE FIBROSIS

            PREVENT QUAD ATROPHY

1.  BRACE – LOCKED AT ZERO DEGREES

  1. WB STATUS__________________________________
  2. INCREASE RANGE OF MOTION TO 110 FLEXION AS TOL
  3. EXERCISES

MULTI-ANGLE ISOMETRICS 60, 40, 20 DEGREES

QUAD SETS

KNEE EXTENSION 60-0 (4-5 X DAILY)

INTERMITTENT ROM 0-60 (4-5 X DAILY)

WELL LEG BICYCLE

E-STIM

CONTINUE ICE

NO HAMSTRING EXERCISES

  1. PROGRESSIVE PHASE:      (WEEK 6-8)

1.  BRACE REMOVED (CONVERT TO CUSTOM BRACE ONCE GOOD QUAD CONTROL)

2.  CUSTOM BRACE FOR AMBULATION

3.  MOTION TO 120 AS TOL- MAX

  1. WEIGHT BEARING: PROGRESS TO WBAT
  2. EXERCISES

WALL SLIDES (0-45 DEGREES)

MINI SQUATS (0-45)

LEG PRESS (0-60)

KNEE EXTENSION 60-0 DEGREES

PROPRIOCEPTION DRILLS (CUP WALKING)

BIODEX STABILITY SYSTEM

WEIGHT SHIFTS

POOL WALKING

INITIATE BIKE FOR ROM

NORMALIZE GAIT PATTERN

HIP EXERCISES FL, ABD, ADD, EX (KNEE EXT)

  1. INCREASE PROGRESSIVE PHASE  (8-12)
    1. CUSTOM BRACE FOR ACTIVIES
    2. WBAT
    3. FULL MOTION
    4. FULL QUAD STRENGTH
    5. EXERCISES:

KNEE EXTENSION

MULTI HIP

LEG PRESS 0-6/75

VERTICALSQUATS 0-45

WALL SQUATS 0-60

LATERAL STEP UPS

FRONT LUNGES

PROPRIOCEPTION DRILLS

SLINGL LEG BALANCE

CUP WALKING

HEEL TOE RAISES

STRETCH HAMSTRINGS AND CALF

PROGRESS POOL EXERCISES

GRADUAL STAIRMASTER, ELLIPTICAL

CONTINUE BALANCE AND PROPRIOCEPTION ACTIVITIES

SEATED CALF RAISES

NO HAMSTRING STRENGTHENING EXERCISES

  1. LIGHT ACTIVITY PHASE:  (3 – 5 MONTHS)

GOALS:   DEVELOPMENT OF STRENGTH, POWER AND ENDURANCE

BEGIN TO PREPARE FOR RETURN TO FUNCTIONAL ACTIVITIES

  1. BRACE FOR PROTECTED ACTIVITIES
  2. EXERCISES:

            CONTINUE ALL PREVIOUS EXERCISES

            INITATE POOL RUNNING (FORWARD ONLY)

            INITIATE HAMSTRING CURLS (0-60) LOW WEIGHT AT 4 MONTHS

            BICYCLE FOR ENDURANCE (30MIN)

            BEGIN WALKING PROGRAM

            CONTINUE ECCENTRICS

    CONTINUE MIN-SQUATS/LAT STEP UPS/WALL SQUATS, FRONT STEP    DOWNS/KNEE EXTENSION

     CLOSED KINETIC REHAB

    CONTINUE ENDURANCE EXERCISES

    PROGRESS TO ALL STRENGTHENING EXERCISES, EMPHASIS ON QUAD STRENGTH

  1. RETURN TO ACTIVITY (6 - 8 MONTHS)

      ADVANCE REHABILITATION TO COMPETITIVE SPORTS

            CLOSED KINETIC REHABILITATION

            HIGH SPEED ISOKINETICS

            RUNNING PROGRAM

            AGILITY DRILLS

            BALANCE AND PROPRIOCEPTION TRAINING

                        PLYOMETRICS TRAINING

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