Sports Medicine Institute, University of Minnesota
NOTE:
The range of motion allowed after posterior cruciate ligament reconstructive surgery is
dependent upon the stability obtained at the time of surgery. Range of motion exercises
are initiated at the surgeon’s discretion in the initial six weeks postoperatively.
GOALS:
1. Learn 0-6 weeks home exercise program prior to hospital discharge.
No weight bearing, with crutches, should be followed for six weeks (until the bone plugs heal in the tunnel).
Weaning off crutches should start with use of crutch on contralateral side at 6 weeks.
This crutch may be discontinued when the patient can walk without a limp.
簡言之，前六週因為怕重建手術的骨隧道尚未癒合，因此並不負重已進行鍛鍊。
六週過後則可以開始使用單拐，直到你不會一跛一跛的走才可以不用拐杖。
2. Patient should attend physician and/or physical therapy follow-up to
assess range of motion and overall tibiofemoral joint stability after
reconstruction.
病人必須尊崇手術醫師或是物理治療的醫囑以達到重建手術過後的穩定性。
3. Patient may initiate closed chain exercises as able. With the foot planted
in closed chain exercises, there is less shear on the reconstruction. Closed
chain activities may include:
A. Biking with no resistance (once knee flexion to 115 degrees achieved).
B. Stair climbers (at 6 weeks)
C. Wall sits (at 6 weeks)
在術後六週以後，可以開始進行 closed chain exercises，包括爬樓梯、依靠著牆壁往下坐與騎固定式腳踏車。
4. Avoid open chain hamstring work - this may put extra stress on the
healing graft until the bone tunnels have healed (4 months).
開始進行 open chain hamstring work 則要在四個月後，因為此動作對於骨隧道具有額外的壓力，怕會影響到。
Frequently Asked Questions:
1. Bathing/showering - 7-10 days postop - once surgical
incision has completely healed.
2. Automobile driving - 6-8 weeks postop (for right knee or clutch foot)
3. Full weight bearing without crutches - starting at 6 weeks postop
with physician clearance once there is no limp.
WEEK 0-3:
1. Straight Leg Raises in brace. Do not allow knee flexion.
Hold for 5 seconds and lower. (build up to 10 sets, 30 reps,
per day)
2. Hip Extension exercises. While standing against a counter,
desk, or table, lift operative limb (with the knee braced)
behind you. Avoid bending forward at the waist. (build up to
10 sets, 10 reps per day).
3. Hip Abduction exercises. While standing, in brace, and
holding onto a counter or table, lift the opeartive limb out to
the side. Hold for 5 seconds, then relax slowly (build up to
10 sets, 10 reps., per day)
4. Range of Motion. Verify extent with surgeon. Gentle
active-assisted ROM (flex heel of operative limb against
ankle of contralateral limb and gently flex) to maximum of 90
degrees. Perform with brace on. Protect against posterior
tibial sagging during this program.
5. Quadriceps Sets. Fire quadriceps muscle mass and hold
for 6 seconds, then relax for 3 seconds (10 sets of 30 reps.,
per day).
*Special consideration for first 6 weeks, place pillow under proximal tibia
at rest to prevent posterior sag.
WEEK 4-6:
1. Range of Motion. Patient may begin to come out of brace
to work on ROM. The brace must be worn for protection
whenever the patient is up. Continue active assisted range of
motion to 90 degrees.
2. Straight Leg Raises. 10 sets, 30 reps., per day - done in
brace - no sag allowed.
3. Quadriceps Sets. 10 sets, 30 reps., per day
4. Hip Extension. 10 sets, 10 reps., per day
5. Hip Abduction. 10 sets, 10 reps., per day. May also be
performed by lying on nonoperative side and lifting operative
limb towards the ceiling. Be careful that hip and leg do not
roll forward with this exercise.
WEEK 6-12:
GOALS:
1. Normal gait pattern, initiate weight bearing.
2. Improve quadriceps muscle tone, girth.
3. Improvement of range of motion from full extension to at
least 125 degrees of flexion.
PROGRAM:
1. Range of Motion. Active, active assisted, passive ROM
exercises four times a day.
2. Ambulation. Progress to one crutch on the nonoperative
side once normal gait pattern is achieved with full weight
bearing on crutches. The one crutch must come forward and
make ground contact in synchrony with the operative limb.
Once a normal gait pattern is established, the crutch may be
discarded. There should be no limping as this will promote
posterior tibialis pain, semimembranosis bursitis, and
sacroiliac joint dysfunction.
3. Continue straight leg raises, quadriceps sets, hip extension,
and hip abduction exercises daily. Weight may be added
proximal to the knee joint (on the thigh) as strength permits.
4. Stationary Bicycle. Once 115 degrees of flexion is
achieved, the use of a stationary bike is allowed. The seat
height should be set so that the lower leg should have the
knee flexed a little. Start off with no resistance. Progress from
5 minutes to 20 minutes as strength permits. The foot should
be placed slightly forward on the pedal (without toe clips) to
minimize hamstring activity.
5. Calf Raises. Perform with knee straight with heels over the
edge of a step or curb. Perform 3 sets daily of 10 repetitions
done slow and fast (each).
6. Hamstring Curls. Perform standing and lift heel up behind
you. Lift a maximum of 5 pounds of ankle weights until 8
weeks postop.
7. Swimming. Allowed but no whip kick. Ambulation in chest
high water also permitted. (Laps around pool or lane)
8. Stairmaster. Permitted at 8 weeks. Progress as tolerated
with low resistance initially. Work up to ten to twelve minutes
per day.
9. Wall Slides (from 0-45 degrees). Progress to mini-squats
as tolerated.
10. Pool Ambulation allowed. Work on normal gait
mechanics in ambulation in pool (heel-toe gait).
11. Leg Presses - Light weight, to maximum of 90 degrees of
knee flexion (start off at 25% of body weight).
WEEK 13-16:
1. Straight Leg Raises. May move weight to tibial tubercle
region and progress distally on the tibia an inch/week.
Maximum of 10 pounds.
2. Continue hip abductors, quadriceps sets, hip extension
exercises.
3. Stationary Bicycle. Increase resistance as tolerated. Thighs
should feel "drained" once get off bike, but should not feel
exhausted.
4. Range of Motion Program. Flexion should achieve to 125
degrees or full flexion by this point.
5. Ambulation. Ambulation out of brace on level ground
permitted. Start off at ¼ mile and progress to 2 miles at a
brisk pace everyday. There should be no limping.
6. Swimming. Continue same program. No whip kicks
allowed.
7. Hamstring Curls, Calf Raises. Continue daily.
8. Stairmaster. Work up to 12-16 minutes per session.
Increase resistance as tolerated.
9. Squats. Three quarter squats, 20 reps., 10 sets, everyday.
Initially perform with no weights and progress to ½ body
weight as strength/endurance allows.
WEEK 17-20:
GOALS:
1. Achieve full range of motion by this point. It is not unusual
for the last 10-15 degrees of knee flexion to take up to 5
months to achieve.
2. Want quadriceps to be 70% of body weight/unaffected
leg. Thigh circumference measured at 15 cm above the
superior pole of the patella should be within 2 cm of the
contralateral (normal) thigh.
3. Progress functionally in activities and avoid patellofemoral
irritation.
PROGRAM:
1. Follow week 13-16 protocol.
2. May progress to run/jog once thigh circumference is within
2 cm of unaffected/nonoperative thigh. Initially jog ¼ mile and
repeat. Build up to 2 miles per day. Add 1/8 - ¼ mile per
week as strength permits. Walk ½ mile at end of session at
brisk pace to cool down.
WEEK 21-ON:
GOALS:
1. Continue with functional training program on a daily basis
(walk/run, biking stairmaster, squats, exercises).
2. Practice sport of choice on own in a noncompetitive
manner.
3. Add ACL agility drill program.
RETURN TO SPORTS/WORK:
1. Want quadriceps to be at least 80% of body
weight/contralateral side.
2. No pivot sports for 6 months.
3. No contact sports for 9 months unless cleared by surgeon.
4. May be fit for functional brace once thigh circumference is
within 1" of normal side.
*Returning to sports means the presence of the necessary joint range of
motion, muscle strength and endurance, and proproception to safely return
to work or athletic participation.
KEY POINTS TO CLINICAL FOLLOW-UP:
1. Six Weeks. Must achieve full extension. Lateral knee x-ray taken to
confirm healing of bone tunnels. Patients with allografts may experience
some mild delayed healing of the tunnels. (This is normal).
2. Twelve Weeks. Achieve flexion to 125 degrees.
3. Sixteen to Twenty Weeks. Thigh circumference should be within 2.5 cm
(one inch) of normal
(unaffected) side.
4. Six Months. Assessment of return to sports.
5. Yearly. Clinical follow-up to assess subtle changes in stability or any
evidence of early arthritic changes. Notify surgeon of any change of
address so you are not lost to follow-up for our research studies.
2. Patient should attend physician and/or physical therapy follow-up to
assess range of motion and overall tibiofemoral joint stability after
reconstruction.
病人必須尊崇手術醫師或是物理治療的醫囑以達到重建手術過後的穩定性。
3. Patient may initiate closed chain exercises as able. With the foot planted
in closed chain exercises, there is less shear on the reconstruction. Closed
chain activities may include:
A. Biking with no resistance (once knee flexion to 115 degrees achieved).
B. Stair climbers (at 6 weeks)
C. Wall sits (at 6 weeks)
在術後六週以後，可以開始進行 closed chain exercises，包括爬樓梯、依靠著牆壁往下坐與騎固定式腳踏車。
4. Avoid open chain hamstring work - this may put extra stress on the
healing graft until the bone tunnels have healed (4 months).
開始進行 open chain hamstring work 則要在四個月後，因為此動作對於骨隧道具有額外的壓力，怕會影響到。
Frequently Asked Questions:
1. Bathing/showering - 7-10 days postop - once surgical
incision has completely healed.
2. Automobile driving - 6-8 weeks postop (for right knee or clutch foot)
3. Full weight bearing without crutches - starting at 6 weeks postop
with physician clearance once there is no limp.
WEEK 0-3:
1. Straight Leg Raises in brace. Do not allow knee flexion.
Hold for 5 seconds and lower. (build up to 10 sets, 30 reps,
per day)
2. Hip Extension exercises. While standing against a counter,
desk, or table, lift operative limb (with the knee braced)
behind you. Avoid bending forward at the waist. (build up to
10 sets, 10 reps per day).
3. Hip Abduction exercises. While standing, in brace, and
holding onto a counter or table, lift the opeartive limb out to
the side. Hold for 5 seconds, then relax slowly (build up to
10 sets, 10 reps., per day)
4. Range of Motion. Verify extent with surgeon. Gentle
active-assisted ROM (flex heel of operative limb against
ankle of contralateral limb and gently flex) to maximum of 90
degrees. Perform with brace on. Protect against posterior
tibial sagging during this program.
5. Quadriceps Sets. Fire quadriceps muscle mass and hold
for 6 seconds, then relax for 3 seconds (10 sets of 30 reps.,
per day).
*Special consideration for first 6 weeks, place pillow under proximal tibia
at rest to prevent posterior sag.
WEEK 4-6:
1. Range of Motion. Patient may begin to come out of brace
to work on ROM. The brace must be worn for protection
whenever the patient is up. Continue active assisted range of
motion to 90 degrees.
2. Straight Leg Raises. 10 sets, 30 reps., per day - done in
brace - no sag allowed.
3. Quadriceps Sets. 10 sets, 30 reps., per day
4. Hip Extension. 10 sets, 10 reps., per day
5. Hip Abduction. 10 sets, 10 reps., per day. May also be
performed by lying on nonoperative side and lifting operative
limb towards the ceiling. Be careful that hip and leg do not
roll forward with this exercise.
WEEK 6-12:
GOALS:
1. Normal gait pattern, initiate weight bearing.
2. Improve quadriceps muscle tone, girth.
3. Improvement of range of motion from full extension to at
least 125 degrees of flexion.
PROGRAM:
1. Range of Motion. Active, active assisted, passive ROM
exercises four times a day.
2. Ambulation. Progress to one crutch on the nonoperative
side once normal gait pattern is achieved with full weight
bearing on crutches. The one crutch must come forward and
make ground contact in synchrony with the operative limb.
Once a normal gait pattern is established, the crutch may be
discarded. There should be no limping as this will promote
posterior tibialis pain, semimembranosis bursitis, and
sacroiliac joint dysfunction.
3. Continue straight leg raises, quadriceps sets, hip extension,
and hip abduction exercises daily. Weight may be added
proximal to the knee joint (on the thigh) as strength permits.
4. Stationary Bicycle. Once 115 degrees of flexion is
achieved, the use of a stationary bike is allowed. The seat
height should be set so that the lower leg should have the
knee flexed a little. Start off with no resistance. Progress from
5 minutes to 20 minutes as strength permits. The foot should
be placed slightly forward on the pedal (without toe clips) to
minimize hamstring activity.
5. Calf Raises. Perform with knee straight with heels over the
edge of a step or curb. Perform 3 sets daily of 10 repetitions
done slow and fast (each).
6. Hamstring Curls. Perform standing and lift heel up behind
you. Lift a maximum of 5 pounds of ankle weights until 8
weeks postop.
7. Swimming. Allowed but no whip kick. Ambulation in chest
high water also permitted. (Laps around pool or lane)
8. Stairmaster. Permitted at 8 weeks. Progress as tolerated
with low resistance initially. Work up to ten to twelve minutes
per day.
9. Wall Slides (from 0-45 degrees). Progress to mini-squats
as tolerated.
10. Pool Ambulation allowed. Work on normal gait
mechanics in ambulation in pool (heel-toe gait).
11. Leg Presses - Light weight, to maximum of 90 degrees of
knee flexion (start off at 25% of body weight).
WEEK 13-16:
1. Straight Leg Raises. May move weight to tibial tubercle
region and progress distally on the tibia an inch/week.
Maximum of 10 pounds.
2. Continue hip abductors, quadriceps sets, hip extension
exercises.
3. Stationary Bicycle. Increase resistance as tolerated. Thighs
should feel "drained" once get off bike, but should not feel
exhausted.
4. Range of Motion Program. Flexion should achieve to 125
degrees or full flexion by this point.
5. Ambulation. Ambulation out of brace on level ground
permitted. Start off at ¼ mile and progress to 2 miles at a
brisk pace everyday. There should be no limping.
6. Swimming. Continue same program. No whip kicks
allowed.
7. Hamstring Curls, Calf Raises. Continue daily.
8. Stairmaster. Work up to 12-16 minutes per session.
Increase resistance as tolerated.
9. Squats. Three quarter squats, 20 reps., 10 sets, everyday.
Initially perform with no weights and progress to ½ body
weight as strength/endurance allows.
WEEK 17-20:
GOALS:
1. Achieve full range of motion by this point. It is not unusual
for the last 10-15 degrees of knee flexion to take up to 5
months to achieve.
2. Want quadriceps to be 70% of body weight/unaffected
leg. Thigh circumference measured at 15 cm above the
superior pole of the patella should be within 2 cm of the
contralateral (normal) thigh.
3. Progress functionally in activities and avoid patellofemoral
irritation.
PROGRAM:
1. Follow week 13-16 protocol.
2. May progress to run/jog once thigh circumference is within
2 cm of unaffected/nonoperative thigh. Initially jog ¼ mile and
repeat. Build up to 2 miles per day. Add 1/8 - ¼ mile per
week as strength permits. Walk ½ mile at end of session at
brisk pace to cool down.
WEEK 21-ON:
GOALS:
1. Continue with functional training program on a daily basis
(walk/run, biking stairmaster, squats, exercises).
2. Practice sport of choice on own in a noncompetitive
manner.
3. Add ACL agility drill program.
RETURN TO SPORTS/WORK:
1. Want quadriceps to be at least 80% of body
weight/contralateral side.
2. No pivot sports for 6 months.
3. No contact sports for 9 months unless cleared by surgeon.
4. May be fit for functional brace once thigh circumference is
within 1" of normal side.
*Returning to sports means the presence of the necessary joint range of
motion, muscle strength and endurance, and proproception to safely return
to work or athletic participation.
KEY POINTS TO CLINICAL FOLLOW-UP:
1. Six Weeks. Must achieve full extension. Lateral knee x-ray taken to
confirm healing of bone tunnels. Patients with allografts may experience
some mild delayed healing of the tunnels. (This is normal).
2. Twelve Weeks. Achieve flexion to 125 degrees.
3. Sixteen to Twenty Weeks. Thigh circumference should be within 2.5 cm
(one inch) of normal
(unaffected) side.
4. Six Months. Assessment of return to sports.
5. Yearly. Clinical follow-up to assess subtle changes in stability or any
evidence of early arthritic changes. Notify surgeon of any change of
address so you are not lost to follow-up for our research studies.
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