Orthopaedic Surgeon
Multiligament Knee Reconstruction Surgical Rehabilitation
Phase I (Surgery to 2 weeks postoperative)
Appointments
• Home exercise program will begin immediately after surgery
Rehabilitation Goals
-
Protection of the post-surgical knee
-
Range of motion: full extension – 90 degrees flexion under the
guidance of PT
-
Normalize quad activation
-
Eliminate effusion
Precautions
-
NWB or TTWB for 2 weeks
-
Remain in brace to protect graft locked in extension for
ambulation.
Suggested Therapeutic Exercise
-
Ankle pumps
-
Passive knee extension to zero
-
SLR 4 directions with brace
-
Short arc quads (60 deg to 30 deg) with Neuromuscular
Electrical Stimulation (NMES)
-
Quad sets
-
Hamstring stretches
-
Patellar mobilizations
Cardiovascular exercise
• Upper body circuit training or upper body ergometer (UBE)
Progression Criteria
-
0-90 degrees range of motion
-
Minimal effusion
Phase II (weeks 2-6)
Appointments
-
Rehabilitation appointments are 2-3 times per week
Rehabilitation Goals
-
Absolute control of external forces and protect graft
-
Nourish articular cartilage with motion
-
Decrease swelling
-
Prevent quad atrophy
Precautions
-
TTWB as tolerated
-
Avoid hyperextension
Suggested Therapeutic Exercise
Week 2
-
Ankle pumps
-
Passive knee extension to zero
-
SLR 4 directions with brace
-
Short arc quads (60 deg to 30 deg) with NMES
-
Quad sets
-
Hamstring stretches
-
Patellar mobilizations
Cardiovascular exercise
-
Upper body circuit training or UBE
-
Week 4: Stair climber, elliptical
Progression Criteria
-
Normal gait on level surface
-
Good leg control without extensor lag, pain, or apprehension
Phase III (weeks >7 to 12 months)
Appointments
-
Rehabilitation appointments are 1-3 times per week
Rehabilitation Goals
-
Absolute control of external forces and protect graft
-
Nourish articular cartilage with motion
-
Decrease swelling
-
Prevent quad atrophy
-
AROM goals: 0-110 degrees by week 11; full by month 3-4
Precautions
-
WBAT as tolerated
-
Avoid hyperextension
Suggested Therapeutic Exercise
-
Ankle pumps
-
Passive knee extension to zero
-
SLR 4 directions with brace
-
Short arc quads (60 deg to 30 deg) with NMES
-
Quad sets
-
Hamstring stretches
-
Patellar mobilizations
-
Stationary bicycle (starting at 5 weeks post-op)
-
Continue quad sets, straight leg raises, and short arc quads
with NMES as needed
-
Add OKC flexion (hamstring curls with low or no weight) at 8
weeks
-
Add quadriceps stretching at 3 months; add ITB stretching at 3
months (not for LCL/PCL reconstructions)
-
Add partial CKC squats (Total Gym) at week 6; 10-40 degrees;
may progress to 0-70 deg at month 3
-
Also at month 3, begin balance retraining
-
Running may be added at 6 months; cutting may be added at 8
month
• Return to full activity may occur at 12 months post-op if the knee shows no signs of instability
Cardiovascular exercise
-
Upper body circuit training or UBE
-
Week 4: Stair climber, elliptical
Progression Criteria
-
Normal gait on level surface
-
Good leg control without extensor lag, pain, or apprehension
-
Critical checkpoints: No patellofemoral s/s (by week 11), No
quad avoid/hypertext/varus thrust (by 3-4 months), no
instability (by 5 months)
-
Return to full activity may occur at 12 months post-op if the
knee shows no signs of instability