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 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

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