PCL Reconstruction: Difference between revisions
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== Description<br> == | == Description<br> == | ||
The operative procedure is performed arthroscopically and the donor site for the graft is usually the ipsilateral semitendinosis / gracilis tendon.<br> | The operative procedure is performed arthroscopically and the donor site for the graft is usually the ipsilateral semitendinosis / gracilis tendon.<br> | ||
== Indication<br> == | == Indication<br> == | ||
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add text here relating to the pre-operative advice | add text here relating to the pre-operative advice | ||
== Post-Op == | == Post-Op<ref>Guy's and St Thomas' NHS Foundation Trust Knee Surgery Unit (2005). Rehabilitation Guidelines following PCL reconstruction</ref> == | ||
The PCL graft is more likely than the ACL to become lax. Therefore the post operative rehabilitation programme is much slower. | |||
The brace is locked at 0˚ for 6 weeks to allow healing of the graft without allowing it to be overstretched. There is less stress placed on the PCL during 0˚ - 60˚ flexion, therefore this range of movement is advocated for exercising in the first three months of the post-operative period. | |||
If there is a combined reconstruction involving both the PCL and the ACL, then rehabilitation will progress according to the isolated PCL protocol. | |||
'''Operative Day''' | |||
Cryocuff applied, Passively flex knee gently to 60˚, Knee brace locked at 0˚ extension, Isometric quadriceps activation / SLR, PWB with elbow crutches (6/52 FWB as tolerated) | |||
'''Day 1 – 14''' | |||
Ensure good quality isometric quadriceps activation is achieved and practised 4 – 5 times daily, Patella mobilisations, Hamstring and calf stretches, Hip abduction / extension exercises | |||
'''Weeks 2 - 6 ''' | |||
Remove brace and ensure knee can gently flex to 60˚passively; this is purely a check, Do not encourage flexion yet, Check patella is fully mobile, Check quadriceps activation especially VMO<br> | |||
'''Weeks 6 – 8''' | |||
Brace unlocked to 90˚ flexion, Multi-angle quadriceps isometric activation, Small knee bends 0˚ - 60˚, Static cycling, CKC exercises e.g. lunges, stepper, cross trainer, rower (0˚ - 60˚), Proprioception exercises e.g. wobble board, trampette, Calf raises, Leg press 60˚ - 0˚, light weights, high repetitions, Swimming – avoid breast stroke | |||
'''Weeks 8 – 12''' | |||
Resisted OKC quadriceps 60˚ - 0˚, Gradually progress proprioceptive challenges, Aim for full range of movement by 12 weeks | |||
'''3 – 4 Months''' | |||
Begin active hamstring exercises no resistance, Progress CKC strengthening and fitness training, Single leg proprioception exercises, By end of 4th month running straight lines on the treadmill | |||
N.B. OKC hamstring exercises to be started at 4 months post-op at the earliest | |||
'''4 – 6 Months''' | |||
Start resisted hamstring exercises sport specific drills, Increase strengthening with OKC and CKC quadriceps and hamstrings, Start low intensity plyometrics – jumping, hopping, skipping, bounding, Progressive jogging and begin sprints, Progress as able to shuttle runs, direction changes, acceleration / deceleration, Sport specific drills, high level proprioception exercises with brace on | |||
'''6 – 12 Months''' | |||
Continuation of advanced sports specific skills, Monitor for signs of swelling, pain, increased laxity / instability, Return to sport when minimal or no pain or swelling, Grade 1 laxity or less, Strength 80% + compared with contralateral leg | |||
Graded return to sport is allowed at this stage with contact sports only beginning one year post-op.<br> | |||
== Key Evidence == | == Key Evidence == | ||
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add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br> | add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br> | ||
== References | == References == | ||
<references /> | <references /> | ||
{{Template:Disclaimer}} | {{Template:Disclaimer}} |
Revision as of 17:05, 27 April 2009
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Description
[edit | edit source]
The operative procedure is performed arthroscopically and the donor site for the graft is usually the ipsilateral semitendinosis / gracilis tendon.
Indication
[edit | edit source]
add text here relating to the indication for the procedure
Clinical Presentation[edit | edit source]
add text here relating to the clinical presentation of the condition
Diagnostic Tests[edit | edit source]
add text here relating to diagnostic tests for the condition
Pre-Op[edit | edit source]
add text here relating to the pre-operative advice
Post-Op[1][edit | edit source]
The PCL graft is more likely than the ACL to become lax. Therefore the post operative rehabilitation programme is much slower.
The brace is locked at 0˚ for 6 weeks to allow healing of the graft without allowing it to be overstretched. There is less stress placed on the PCL during 0˚ - 60˚ flexion, therefore this range of movement is advocated for exercising in the first three months of the post-operative period.
If there is a combined reconstruction involving both the PCL and the ACL, then rehabilitation will progress according to the isolated PCL protocol.
Operative Day
Cryocuff applied, Passively flex knee gently to 60˚, Knee brace locked at 0˚ extension, Isometric quadriceps activation / SLR, PWB with elbow crutches (6/52 FWB as tolerated)
Day 1 – 14
Ensure good quality isometric quadriceps activation is achieved and practised 4 – 5 times daily, Patella mobilisations, Hamstring and calf stretches, Hip abduction / extension exercises
Weeks 2 - 6
Remove brace and ensure knee can gently flex to 60˚passively; this is purely a check, Do not encourage flexion yet, Check patella is fully mobile, Check quadriceps activation especially VMO
Weeks 6 – 8
Brace unlocked to 90˚ flexion, Multi-angle quadriceps isometric activation, Small knee bends 0˚ - 60˚, Static cycling, CKC exercises e.g. lunges, stepper, cross trainer, rower (0˚ - 60˚), Proprioception exercises e.g. wobble board, trampette, Calf raises, Leg press 60˚ - 0˚, light weights, high repetitions, Swimming – avoid breast stroke
Weeks 8 – 12
Resisted OKC quadriceps 60˚ - 0˚, Gradually progress proprioceptive challenges, Aim for full range of movement by 12 weeks
3 – 4 Months
Begin active hamstring exercises no resistance, Progress CKC strengthening and fitness training, Single leg proprioception exercises, By end of 4th month running straight lines on the treadmill
N.B. OKC hamstring exercises to be started at 4 months post-op at the earliest
4 – 6 Months
Start resisted hamstring exercises sport specific drills, Increase strengthening with OKC and CKC quadriceps and hamstrings, Start low intensity plyometrics – jumping, hopping, skipping, bounding, Progressive jogging and begin sprints, Progress as able to shuttle runs, direction changes, acceleration / deceleration, Sport specific drills, high level proprioception exercises with brace on
6 – 12 Months
Continuation of advanced sports specific skills, Monitor for signs of swelling, pain, increased laxity / instability, Return to sport when minimal or no pain or swelling, Grade 1 laxity or less, Strength 80% + compared with contralateral leg
Graded return to sport is allowed at this stage with contact sports only beginning one year post-op.
Key Evidence[edit | edit source]
add text here relating to key evidence with regards to any of the above headings
Resources
[edit | edit source]
add appropriate resources here
Case Studies[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
References[edit | edit source]
- ↑ Guy's and St Thomas' NHS Foundation Trust Knee Surgery Unit (2005). Rehabilitation Guidelines following PCL reconstruction
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