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Posterolateral corner rehab protocol

General considerations

  • Full weightbearing as tolerated with hinged brace locked in full extension for 4 weeks.
  • Patient will be instructed to come out of the brace twice a day for gentle, passive stretching into flexion. Avoid active knee flexion for 4 weeks.
  • Regular assessment of gait to watch for compensatory patterns. Watch especially to avoid posterior-lateral knee thrust in stance phase of gait.
  • Regular manual treatment to soft tissue and incisions to decrease the incidence of fibrosis.
  • Avoid direct palpation to surgical portals x4 weeks, “no touch zone” 2 inches from portals. Refer to wound care protocol for full details.
  • No resisted leg extension machines (isotonic or isokinetic) at any point in the rehab process.
  • No high impact or cutting/twisting activities for at least 3 - 4 months post-op.
  • MD/nurse follow-up visits at Day 2, Day 14, 1 month, 4 months, 6 months, and 1 year post-op.

Week 1

  • Nurse visit Day 2 to change dressing and review home program. Icing and elevation regularly.

Manual

  • Soft tissue mobilization to quadriceps, posterior musculature, suprapatellar pouch, popliteal fossa, iliotibial band, Hoffa’s fat pads.

Exercises

  • Straight leg raise exercises (lying, seated, and standing), quadriceps/adduction/gluteal sets/abduction exercises.
  • Hip and foot/ankle exercises, well-leg stationary cycling, upper body conditioning.
  • No active range of motion knee flexion x 4 weeks

Goals

  • Passive range of motion knee flexion <70 degrees Passive knee extension 0 degrees

Gait

  • Full weight bearing with brace locked in full extension

Weeks 2 - 4

  • Nurse visit at 14 days for suture removal and check-up.

Manual

  • Manual resisted (i.e. PNF patterns) of the foot, ankle, and hip.
  • Continue with pain control, range of motion, soft tissue treatments, and proprioception exercises.

Exercises

  • Non-weightbearing aerobic exercises (i.e. unilateral cycling, upper body ergometer, Schwinn Air-Dyne non-involved limb and arms only).
  • Trunk and gluteal stabilization program.
  • No active range of motion knee flexion x 4 weeks

Goals

  • Passive range of motion 0 to 90 degrees

Gait

  • full weight bearing with brace locked in full extension

Weeks 4 - 6

  • MD visit at 4 weeks post-op; will wean off use of rehab brace. Brace range of motion can be set at open during wean off process.

Manual

  • Manual treatments to work on full range of motion flexion and extension, initiate scar mobilization once portals completely closed.

Exercises

  • Stretches for full range of motion.
  • Incorporate functional exercises (i.e. knee bends/squats, calf raises, step-ups, proprioception).
  • Stationary bike and progressing to road cycling as tolerated.
  • Slow walking on treadmill for gait (preferably a low-impact treadmill).
  • Pool/deep water workouts (once incisions are healed).

Goals

  • Initiate active range of motion knee flexion.

Gait

  • Unlock brace, slow transition to wean off brace.

Weeks 6 - 8

  • Increase the intensity of functional exercises (i.e. cautiously increase depth of closed-chain exercises, Shuttle/leg press). Do not overload closed- or open-chain exercises.
  • Add lateral training exercises (i.e. side-step-ups, lateral stepping) once adequate mechanics are achieved.

Goals

  • Patients should be progressing to walking without a limp.
  • Range of motion should be at least 80%

Weeks 8 - 12

  • Introduce more progressive single-leg exercise (i.e.Theraband leg press, single-leg calf raises).
  • Careful analysis of gait and mechanics with corrective treatment (i.e. orthotics, gluteal strengthening).
  • Patients should be pursuing a home program with emphasis on sport/activity-specific training.

Weeks 12 - 16

  • Low-impact activities until able to demonstrate adequate completion of a functional/sport test.
  • Increasing intensity of strength, power, and functional training for gradual return to activities.

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.

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Kevin R. Stone · Jonathan R. Pelsis · Scott T. Surrette · Ann W. Walgenbach · Thomas J. Turek 

Stone, K.R., A.W. Walgenbach, T.J. Turek, A. Freyer, and M.D. Hill. 2006.