PLC: Rehabilitation PRINCIPLES Dr. Amrish Kumar Jha Ms (Ortho) Visiting Consultant ILS Multispecialty Hospitals, Dumdum, Kolkata Visiting Consultant Medica Superspeciality Hospitals, Kolkata

FOLLOW UP VISITS Very important Should be instructed in early stage Day 2, Day 14, 1 month, 4 months, 6 months, and 1 year post-op.

NO TOUCH ZONE Avoid direct palpation to surgical portals x4 weeks, “No touch zone” 2 inches from portals. Regular manual treatment to soft tissue and incisions to decrease the incidence of fibrosis.

NO No resisted leg extension machines at any point in the rehab process. No high impact or cutting/twisting activities for at least 3 - 4 months post-op.

BRACING Bi-valved cast for the first 4 postoperative weeks “Bi-valved” means that the cast is cut so that it can be removed 4 times a day for passive knee motion exercises.

bracing At 4 weeks postoperative, the cast is removed and replaced with a hinged brace that is locked at 10° of flexion. The brace is removed 4 times each day for range of motion exercises. At 6 weeks postoperative, the brace is unlocked as knee flexion to 110° is encouraged and partial weight bearing allowed.

Weight bearing principles Non weight bearing for the first 2 weeks. Partial weight bearing: postoperative weeks 3-4 Full weight bearing by week 8 with cane or crutch support. A cane or crutch is used for approximately another 3 to 4 weeks if needed.

ISSUES Patellar mobilization Flexibility exercises Electrical muscle stimulation Cryotherapy Biofeedback Strengthening and Conditioning programs.

CONSIDERATION IN ATHLETES In athletes running program is begun at approximately the 9th postoperative month Sports specific training programs are initiated at the 12th postoperative month. However, the majority of patients who require major posterolateral ligament reconstructive procedures do not desire to return to high- impact sports and therefore, this advanced conditioning and training is usually not required.

SUMMARY Full weight bearing as tolerated with hinged brace locked in full extension for 4 weeks. 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.