 
 
Rehabilitation Protocol for PCL Reconstruction  
 
This protocol is intended to guide clinicians through the post-operative course for PCL reconstruction. This protocol is 
time based (dependent on tissue healing) as well as criterion based. Specific intervention should be based on the needs 
of the individual and should consider exam findings and clinical decision making. The timeframes for expected outcomes 
contained within this guideline may vary based on surgeon’s preference, additional procedures performed, and/or 
complications. If a clinician requires assistance in the progression of a post-operative patient, they should consult with 
the referring surgeon. 
 
The interventions included within this protocol are not intended to be an inclusive list. Therapeutic interventions should 
be included and modified based on the progress of the patient and under the discretion of the clinician. 
 
Post-operative considerations 
If the patient develops a fever, unresolving numbness/tingling, excessive drainage from the incision, uncontrolled pain 
or any other symptoms you have concerns about you should contact the referring physician. 
 
PHASE I: IMMEDIATE POST-OP PHASE (0-4 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Protect graft 
• Reduce swelling, minimize pain 
• Restore patellar mobility 
• Restore full extension, gradually improve flexion 
• Minimize arthrogenic muscle inhibition, re-establish quad control, regain full active extension 
• Patient education 
- Keep your knee straight and elevated when sitting or laying down 
- Support the entire limb when extended 
- Do not pivot on your surgical side 
- Return to driving: 6-8 weeks post-op 
Weight Bearing  
Partial Weight Bearing (PWB) with crutches, braced locked in extension with all ambulation and 
sleeping 
Precautions 
• Avoid hamstring activation or guarding 
• Avoid hyperextension activities 
• Prevent posterior tibial translation 
Intervention 
Swelling Management 
• Ice, compression, elevation (check with MD re: cold therapy)  
• Retrograde massage    
 
Range of motion/Mobility 
• Gentle PROM *avoid hamstring guarding 
• Patellar Mobilizations: superior/inferior and medial/lateral  
• Seated active-assisted knee flexion 
 
Therapeutic Exercise 
• Ankle pumps 
• Quadriceps sets  
• Straight leg raise (SLR) 
• Sidelying and standing hip abduction/adduction  
• Standing hip extension from neutral 
• Resisted plantarflexion in long sitting, progressing to standing calf raise with full knee extension 
• Functional electrical stimulation (as needed for trace to poor quadriceps control) 
 
 
Criteria to 
Progress 
• Good quadriceps control (no lag with SLR) 
• Full knee extension 
• >60 degrees of knee flexion PROM 
• No signs of active inflammation 
 
PHASE II: PROTECTION PHASE (4-12 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Increase knee ROM, particularly flexion 
• Normalize gait 
• Improve quadriceps strength and hamstring flexibility 
Weight Bearing 
During this phase, the brace is progressively unlocked (when able to perform SLR) and weight 
bearing increased: 
• Weeks 4-6: WBAT with crutches, brace unlocked for gait in controlled environment only 
• Weeks 6-8: WBAT with crutches, brace unlocked for all activities  
• Week 8: brace discontinued (as allowed by surgeon). Patient may discontinue crutches if they 
demonstrate the following: 
- No quadriceps lag with SLR 
- Full knee extension 
- Knee flexion AROM 90-100 degrees 
- Normal gait pattern (may use 1 crutch/cane until gait normalized) 
 
Precautions 
• Avoid hamstring activation or guarding 
• Avoid hyperextension activities 
• Prevent posterior tibial translation 
Additional 
Interventions 
*Continue with 
Phase I 
interventions as 
indicated 
Therapeutic Exercise: exercise progressions below should be in respect to timeline of healing as well as 
patient ability to perform appropriately, if unable to perform with proper form, delay adding to 
program 
 
Weeks 4-8:  
• Wall slides (0-45 degrees knee flexion) 
• Leg press (0-60 degrees knee flexion) 
• Standing 4 way hip exercise for resisted hip flexion, extension, abduction, and adduction. Place 
resistance above knee for hip abduction and adduction 
• Sidelying hip external rotation-clamshell  
• Hooklying transversus abdominus progression 
 
Weeks 8-12:  
• Stationary bike (foot placed forward on pedal without use of toe clips to minimize hamstring 
activity, seat height slightly higher than normal), Elliptical trainer 
• Gait training over level ground 
• Closed kinetic chain terminal knee extension using resistance band or weight machine 
• Mini squats (0-90 degrees knee flexion) 
• Leg press (0-90 degrees knee flexion) 
• Seated calf raises 
 
Balance/Proprioception 
• Single leg standing balance (knee slightly flexed) static progressed to dynamic and level 
progressed to unsteady surface  
Criteria to 
Progress 
• No effusion/swelling/pain after exercise 
• Normal gait 
• ROM equal to contra lateral side 
 
PHASE III: LATE POST-OP (3-6 MONTHS AFTER SURGERY) 
Rehabilitation 
Goals 
• Safely progress strengthening  
• Promote proper movement patterns 
• Avoid post exercise pain/swelling 
 
 
Additional 
Interventions 
*Continue with 
Phase I-II 
Interventions as 
indicated 
Strengthening 
• Gym equipment: leg press machine, hip abductor and adductor machine, hip extension machine, 
roman chair, seated calf machine  
**The following exercises to focus on proper control with emphasis on good proximal stability  
• Squat to chair 
• Lateral lunges 
• Romanian dead lift 
• Single leg progression:  
- Single leg press, slide board lunges: retro and lateral, step ups with march, lateral step-
ups, step downs, single leg squats, single leg wall slides 
• Knee exercises for additional exercises 
• Bridges & single leg bridges 
 
Balance/Proprioception 
• Lateral step overs 
• Joint position sense 
• Progress single limb balance including perturbation training  
 
Conditioning 
• Treadmill walking 
• Jogging in pool with vest or belt 
• Swimming (no breast stroke or “frog kick”) 
Criteria to 
Progress 
• Clearance by surgeon to resume full or modified activity  
• Full, pain-free AROM and PROM, muscle strength and endurance, and proprioception 
• Quadriceps/HS/Hip strength 80% of uninvolved leg measured with hand-held dynamometer 
(HHD) 
 
PHASE IV: ADVANCED STRENGTHENING AND EARLY RETURN TO SPORT (6-9 MONTHS 
AFTER SURGERY) 
Rehabilitation 
Goals 
• Safe and gradual return to work or athletic participation 
• Patient education on possible limitations, with patient demonstrating clear understanding 
• Maintenance of strength, endurance, and function 
• Safely initiate sport specific training program 
Additional 
Interventions 
*Continue with 
Phase II-III 
interventions as 
indicated 
Therapeutic Exercise 
• Continue closed kinetic chain exercise progression 
• Interval running program 
- Return to Running Program 
• Progress to plyometric and agility program (with functional brace if prescribed)  
- Agility and Plyometric Program  
Criteria to 
Progress 
• Clearance from MD and ALL milestone criteria below have been met  
• Completion jog/run program without pain/effusion/swelling  
• Functional Assessment  
- Quad/HS/glut index ≥90%; HHD mean or isokinetic testing @ 60d/s  
- Hamstring/Quad ratio ≥66%  
- Hop Testing ≥90% compared to contra lateral side, demonstrating good landing 
mechanics 
• KOOS-sports questionnaire >90%  
• International Knee Committee Subjective Knee Evaluation >93  
• Psych Readiness to Return to Sport (PRRS)  
 
PHASE V: UNRESTRICTED RETURN TO SPORT (9+ MONTHS AFTER SURGERY) 
Rehabilitation 
Goals 
• Continue strengthening and proprioceptive exercises  
• Symmetrical performance with sport specific drills  
• Safely progress to full sport 
 
 
Additional 
Interventions 
*Continue with 
Phase II-IV 
interventions as 
indicated 
• Multi-plane sport specific plyometrics program  
• Multi-plane sport specific agility program  
• Include hard cutting and pivoting depending on the individuals’ goals  
• Non-contact practice→ Full practice→ Full play 
Discharge Criteria 
Successful completion of all phases of rehabilitation and independent home exercise 
program/progression established.  
 
For the recreational or competitive athlete, return-to-sport decision making should be 
individualized and based upon factors including but not limited to previous injury history, the level 
of demand on the lower extremity, contact vs non-contact, and frequency of participation. Close 
discussion with the referring surgeon is strongly recommended prior to advancing to a return-to-
sport rehabilitation program. 
   Revised 10/2021 
 
Contact 
Please email MGHSportsPhysicalTherapy@partners.org with questions specific to this protocol 
 
References: 
 
1. 
de Paula Leite Cury, R., Kiyomoto, H., Rosal, G., Bryk, F., de Oliveira, V. and de Camargo, O., 2012. REHABILITATION PROTOCOL AFTER ISOLATED 
POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION. Revista Brasileira de Ortopedia (English Edition), 47(4), pp.421-427. 
2. 
Hammoud, S., Reinhardt, K. and Marx, R., 2010. Outcomes of Posterior Cruciate Ligament Treatment: A Review of the Evidence. Sports Medicine and 
Arthroscopy Review, 18(4), pp.280-291. 
3. 
Lien, O., Aas, E., Johansen, S., Ludvigsen, T., Figved, W. and Engebretsen, L., 2010. Clinical outcome after reconstruction for isolated posterior 
cruciate ligament injury. Knee Surgery, Sports Traumatology, Arthroscopy, 18(11), pp.1568-1572. 
4. 
Pierce, C., O’Brien, L., Griffin, L. and LaPrade, R., 2012. Posterior cruciate ligament tears: functional and postoperative rehabilitation. Knee Surgery, 
Sports Traumatology, Arthroscopy, 21(5), pp.1071-1084. 
5. 
Quelard, B., Sonnery-Cottet, B., Zayni, R., Badet, R., Fournier, Y., Hager, J. and Chambat, P., 2010. Isolated posterior cruciate ligament reconstruction: 
Is non-aggressive rehabilitation the right protocol?. Orthopaedics & Traumatology: Surgery & Research, 96(3), pp.256-262. 
6. 
Rauck, R., Nwachukwu, B., Allen, A., Warren, R., Altchek, D. and Williams, R., 2018. Outcome of isolated posterior cruciate ligament reconstruction at 
mean 6.3-year follow up: a consecutive case series. The Physician and Sportsmedicine, 47(1), pp.60-64. 
7. 
Senese, M., Greenberg, E., Todd Lawrence, J. and Ganley, T., 2018. REHABILITATION FOLLOWING ISOLATED POSTERIOR CRUCIATE LIGAMENT 
RECONSTRUCTION: A LITERATURE REVIEW OF PUBLISHED PROTOCOLS. International Journal of Sports Physical Therapy, 13(4), pp.737-751. 
8. 
Simhal, R., Bovich, M., Bahrun, E. and Dreese, J., 2021. Postoperative Rehabilitation of Posterior Cruciate Ligament Surgery: A Systematic 
Review. Sports Medicine and Arthroscopy Review, 29(2), pp.81-87. 
9. 
Zayni, R., Hager, J., Archbold, P., Fournier, Y., Quelard, B., Chambat, P. and Sonnery-Cottet, B., 2011. Activity level recovery after arthroscopic PCL 
reconstruction: A series of 21 patients with a mean follow-up of 29months. The Knee, 18(6), pp.392-395. 
 
 
 
 
 
Return to Running Program 
  
This program is designed as a guide for clinicians and patients through a progressive return-to-run program. Patients 
should demonstrate > 80% on the Functional Assessment prior to initiating this program (after a knee ligament or 
meniscus repair). Specific recommendations should be based on the needs of the individual and should consider clinical 
decision making. If you have questions, contact the referring physician.   
  
PHASE I: WARM UP WALK 15 MINUTES, COOL DOWN WALK 10 MINUTES  
Day  
1  
2  
3  
4  
5  
6  
7  
Week 1  
W5/J1x5  
  
W5/J1x5  
  
W4/J2x5  
  
W4/J2x5  
Week 2  
  
W3/J3x5  
  
W3/J3x5  
  
W2/J4x5  
  
Week 3  
W2/J4x5  
  
W1/J5x5  
  
W1/J5x5  
  
Return to 
Run   
Key: W=walk, J=jog  
**Only progress if there is no pain or swelling during or after the run  
  
PHASE II: WARM UP WALK 15 MINUTES, COOL DOWN WALK 10 MINUTES  
Week  Sunday  
Monday  Tuesday  
Wednesday  
Thursday  Friday  
Saturday  
1  
20 min  
  
20 min  
  
20 min  
  
25 min  
2  
  
25 min  
  
25 min  
  
30 min  
  
3  
30 min  
  
30 min  
  
35 min  
  
35 min  
4  
  
35 min  
  
40 min  
  
40 min  
  
5  
40 min  
  
45 min  
  
45 min  
  
45 min  
6  
  
50 min  
  
50 min  
  
50 min  
  
7  
55 min  
  
55 min  
  
55 min  
  
60 min  
8  
  
60 min  
  
60 min  
  
  
  
Recommendations  
• Runs should occur on softer surfaces during Phase I  
• Non-impact activity on off days  
• Goal is to increase mileage and then increase pace; avoid increasing two variables at once  
• 10% rule:  no more than 10% increase in mileage per week  
 
 
 
 
Agility and Plyometric Program  
  
This program is designed as a guide for clinicians and patients through a progressive series of agility and plyometric 
exercises to promote successful return to sport and reduce injury risk. Patients should demonstrate > 80% on the 
Functional Assessment prior to initiating this program. Specific intervention should be based on the needs of the 
individual and should consider clinical decision making. If you have questions, contact the referring physician.   
  
PHASE I: ANTERIOR PROGRESSION  
Rehabilitation 
Goals  
• Safely recondition the knee  
• Provide a logical sequence of progressive drills for pre-sports conditioning  
Agility  
• Forward run  
• Backward run  
• Forward lean in to a run  
• Forward run with 3-step deceleration  
• Figure 8 run  
• Circle run  
• Ladder   
Plyometrics  
• Shuttle press: Double leg
alternating leg
single leg jumps  
• Double leg:   
- Jumps on to a box
 jump off of a box
 jumps on/off box  
- Forward jumps, forward jump to broad jump  
- Tuck jumps  
- Backward/forward hops over line/cone  
• Single leg (these exercises are challenging and should be considered for more advanced 
athletes):   
- Progressive single leg jump tasks  
- Bounding run  
- Scissor jumps  
- Backward/forward hops over line/cone  
Criteria to Progress  • No increase in pain or swelling  
• Pain-free during loading activities  
• Demonstrates proper movement patterns  
  
PHASE II: LATERAL PROGRESSION  
Rehabilitation 
Goals  
• Safely recondition the knee  
• Provide a logical sequence of progressive drills for the Level 1 sport athlete  
Agility  
*Continue with Phase I 
interventions  
  
• Side shuffle  
• Carioca  
• Crossover steps  
• Shuttle run  
• Zig-zag run  
• Ladder  
Plyometrics  
*Continue with Phase I 
interventions  
• Double leg:   
- Lateral jumps over line/cone  
- Lateral tuck jumps over cone  
• Single leg (these exercises are challenging and should be considered for more advanced 
athletes):   
- Lateral jumps over line/cone  
- Lateral jumps with sport cord  
Criteria to Progress  • No increase in pain or swelling  
• Pain-free during loading activities  
• Demonstrates proper movement patterns  
  
 
 
PHASE III: MULTI-PLANAR PROGRESSION  
Rehabilitation 
Goals  
• Challenge the Level 1 sport athlete in preparation for final clearance for return to sport  
Agility   
*Continue with Phase 
I-II interventions  
• Box drill  
• Star drill  
• Side shuffle with hurdles  
Plyometrics  
*Continue with Phase 
I-II interventions  
• Box jumps with quick change of direction  
• 90 and 180 degree jumps   
Criteria to Progress  • Clearance from MD  
• Functional Assessment  
- Quad/HS/glut index ≥90% contra lateral side (isokinetic testing if available)  
- Hamstring/Quad ratio ≥70%  
- Hop Testing ≥90% contralateral side  
• KOOS-sports questionnaire >90%  
• International Knee Committee Subjective Knee Evaluation >93  
• Psych Readiness to Return to Sport (PRRS) 
 
 
