Post-Operative Instructions: PCL Reconstruction

Pain Medications

  • In most cases local or regional nerve blocks will provide 8-12 hours of numbness. As soon as you start to feel the numbness wearing off, begin taking oral pain medication.

  • Take Tylenol 500mg one tab every 8 hours.

  • Take Aleve (Naproxen) 220mg two tabs (440mg total) every 12 hours with food.

  • If you still have pain after Tylenol and Aleve/Naproxen, take one Norco tab (5mg/325mg).

  • If you still have pain after all of the above, take a second Norco tab.

  • Keep in mind Norco has Tylenol in it (325mg). If you take an extra Norco, then skip a dose of Tylenol.DO NOT exceed 3500mg of Tylenol over 24 hours. 

  • It is illegal to drive or operate machinery with narcotic medications. 

  • Do not combine alcohol or other sedatives with narcotic medications.

  • You do not need to take pain medications once you no longer have pain. You should stop the Norco first (usually 2-3 days), then wean off the others over the next week or two.

Other Medications

  • Take Aspirin 325mg one tab once a day for the first 4 weeks to prevent blood clots.

  • Take Zofran as needed for nausea (usually associated with anesthesia/narcotic meds).

  • Take an over-the-counter stool softener (Docusate/Senna/Miralax) as needed for constipation.

Activity

  • Use crutches to assist with ambulation.

  • You may bear 25% of your weight on your operative extremity for the first two weeks.

  • Elevate your operative extremity above the heart as much as possible to decrease swelling.

  • Avoid prolonged periods standing to prevent excessive pain and swelling.

Recovery Equipment

  • You should wear the knee brace at all times day and night locked in full extension.

  • You may remove the brace to perform the recovery exercises and for hygiene.

Cold Therapy

  • We recommend cold therapy use as much as possible in the first two weeks. 

  • Cold therapy units may be used continuously as instructed.

  • Ice packs should be applied 30 minutes at a time, with 30 minutes off between applications.

  • Do not apply ice directly to the skin to avoid burning.

Recovery Exercises

  • You may perform leg bridges, heel slides (0-90 degrees), quad sets, and ankle exercises as instructed in your preoperative packet.

  • Your motion goal should be to have 0-90 degrees of knee motion at your initial postoperative visit.

  • Begin physical therapy as soon as possible, ideally the day after surgery.

Diet: Please refer to your preoperative packet instructions.

Incision Care: Please refer to your preoperative packet instructions.

Emergencies: Please refer to your preoperative packet instructions.

Post-Operative Rehabilitation: PCL Reconstruction

Therapy Plan: Twice per week for 0-3 months, once per week for 3-6 months

ROM Progression

Passive knee motion for 0-2 weeks after surgery restricted to pain-free range from 0-90 degrees.

Progress ROM as tolerated after 2 weeks with the goal of symmetric full motion at 6-8 weeks.

Weight Bearing Progression

Initial weight bearing 0-2 weeks after surgery should be 25% body weight with the foot flat on the ground.

  • Progress weight bearing over weeks 2-4 with the goal of removing crutches at 4 weeks

  • Do NOT progress to one crutch - gait must be pain free and non-compensatory to remove both crutches

  • Brace (dynamic rebound brace) should remain in place for the first 6 weeks

Initial Post-Operative Physical Therapy Visit

  • Correctly perform 25% maximum body weight foot flat weight bearing with crutches

  • Instruct on leg bridge for extension, heel slides for flexion, ankle pumps

  • Isometric exercises for core, glutes, quadriceps, hamstrings

Phase 1 Physical Therapy (0-6 weeks): protect the joint, progress ambulation

  • NO open-chain exercises

  • Manual therapy 20+ minutes per session, stationary bike 20-60 minutes/day (NO resistance)

  • Soft tissue mobilization, patellar mobilization, isometric exercises, core strengthening

  • Brace locked in extension for ambulation until full control, then may unlock for full motion

  • Tactile and verbal cueing to enable non-compensatory gait patterning

Phase 2 Physical Therapy (6-12 weeks): progressive strengthening

  • Initiate closed-chain strengthening and planks advancing as tolerated

  • Proprioceptive training

  • Standing weight shifts, backward/lateral walking without resistance (NO pivoting)

  • Soft tissue mobilization, patellar mobilization, isometric exercises, core strengthening

  • Initiate step-up and step-down programs

Phase 3 Physical Therapy (12-24 weeks): return to pre-injury level

  • Focus on functional exercises in all planes, advance only when fully controlled

  • Advance closed-chain and core strengthening

  • Proprioceptive training

  • Elliptical and pool running may start at 14 weeks, straight treadmill running may start at 16 weeks

  • Agility drills may start at 18 weeks, sport-specific drills  and plyometrics may start at 20 weeks

Phase 4 Physical Therapy (24+ weeks): return to sport

  • Full return may take a full 6-12 months or more and requires functional assessment prior to return

  • Advance closed-chain and core strengthening as needed

  • Continue proprioceptive training, agility drills, and sport-specific drills as needed