Precautions
- Protect the graft from posterior tibial sag: keep the posterior tibia supported at all times, brace in full extension early, and perform passive flexion with an anterior force on the tibia (prone/supported).
- No isolated (open-chain) hamstring strengthening in early/mid rehab — hamstring pull draws the tibia posteriorly and stresses the graft.
- Emphasize the quadriceps — the dynamic protector of the PCL. Times are guidelines; progression is criterion-based.
Phase 1 · Weeks 0–4 (Protective)
- Brace locked in full extension. Weight bearing: as tolerated (full) with the brace locked in full extension.
- ROM: full extension with the posterior leg supported at all times (protect from tibial sag); flexion to 60°.
- Ankle ROM; quad sets; SAQ 30–0° (weeks 3–4); 3-way SLR in brace (no flexion); NMES for quad; IFC/cryotherapy.
- Manual: patellar mobilizations; STM once the incision is healed; passive knee flexion to 60° with an anterior tibial force. Conditioning: UBE.
Phase 2 · Weeks 5–8 (Early Strengthening)
- Brace: open to 30° (weeks 5–6), 60° (weeks 7–8). Weight bearing: full (maintained from the start in the locked brace).
- ROM: full extension; flexion 90° (week 6) → 110° (week 8). Gait training at 8 weeks; 4-way SLR in brace; heel raises with weight; SAQ/LAQ.
- Begin closed chain if quad control is good: wall sits, mini-squats, step-downs 0–45° (weeks 7–8). Proprioception (single-leg balance) and core.
- Manual: patellar mobilizations; passive flexion to 90° with an anterior tibial force; prone quad stretch to 90°.
Phase 3 · Weeks 9–12 (Advanced Strengthening)
- Brace open; full weight bearing; ROM full extension, flexion progressing to full.
- Quad sets; 4-way SLR in brace; half squats 0–90° (weeks 10–12); step-downs; slow progression of multi-plane closed-chain work.
- Proprioception: wobble/BAPS boards; core. Conditioning: UBE/bike (minimal resistance). Manual: passive flexion to 125° with anterior tibial force; prone quad stretch to 125°.
Phase 4 · Weeks 13–25 (Functional Training)
- Dynamic PCL brace worn until ~4 months (≈week 16), then discontinued. Continue quad strengthening.
- Movement control low/single-plane → high-velocity/multi-plane; progress closed-chain toward open-chain activities.
- Conditioning: elliptical, StairMaster; single-leg and dynamic-balance proprioception; advanced core.
Phase 5 · Week 26+ (Return to Sport Progression)
- Continue quad strengthening; straight-plane running → multidirectional; progress controlled → uncontrolled impact, reactive and plyometric work; sport-specific activities.
- Return to sport is based on provider-team input and appropriate testing — generally not before ~6 months and criterion-based.
References
- Rehabilitation Protocol for PCL Reconstruction. Massachusetts General Hospital.
- PCL Reconstruction — rehabilitation principles. Physiopedia.
All times and exercises are guidelines; actual progress may be faster or slower for each patient, as agreed upon by the patient and their care team.