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First Stage (1st- 15th Day After Injury)

First Stage (1st- 15th Day After Injury). 1- Knee brace locked in extension with pillow under triceps during bed rest (Complete rest for the first 48 hours) (retained when walking for about a month until good quadriceps control is regained) 2- Cryotherapy

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First Stage (1st- 15th Day After Injury)

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  1. First Stage (1st- 15th Day After Injury) • 1- Knee brace locked in extension with pillow under triceps during bed rest (Complete rest for the first 48 hours) (retained when walking for about a month until good quadriceps control is regained) • 2- Cryotherapy • Cryotherapy: ice bag on the knee (20 min six times a day). • Active foot flexion-extension (ankle pump" exercise 5-min every half hour). • 3- Non-steroidal anti-inflammatory drug (NSAID) as required. • 4- Crutches with partial weight bearing • 5-Stretching exercises for the lower leg Calf stretches, hamstring stretch, ankle mobility, pain free knee mobility exercises. • 5- Strengthening exercises (pain free) Isometric quadriceps exercises - static quads, static hamstring holds 6 s, and then resting for 5 s for 5 min/h, calf raises (both legs).

  2. Second Stage (15th -30th Day) Aims • 1- completely eliminate swelling • 2- regain ROM 0°-900 and • 3- build on strengthening exercises.

  3. Second Stage (15th -30th Day) • 1-Recovery of ROM 0°-900 • 2- Isometric exercises for all lower limb muscles continue with phase 1 exercises • also begin to half squats (both legs), hip raises, hip exercises against resistance, step ups, isotonic quadriceps exercises in available range and single leg calf raises.(avoid open chain hamstring exercises) • 3-Electrotherapy of the quadriceps • 4- Start walking with brace but without crutches

  4. Third Stage (30th - 60th Day) • Aims • 1- regain full mobility • 2- build on strengthening exercises. • 3- proprioceptive training • 4- complete weight bearing • 5- By the end of this phase the athlete may be able to do 'proper' cycling or light swimming.

  5. Third Stage (30th - 60th Day) • 1- Recovery of complete ROM • 2- Electrotherapy of the quadriceps • 3- Isometric gymnastics • 4-Semi-squat • 5- Proprioceptive exercises • 6- Complete weight bearing • 7-Swimining (underwater exercises) • 8- Exercise bicycle

  6. Fourth Stage (60th - 90th Day) • Aims • 1- Progress strength exercises • 2- Advanced proprioceptive training • 3- Begin a gradual return to running

  7. Fourth Stage (60th - 90th Day) • 1- Semi-squat • 2- Leg press • 3- Isokinetics • 4- Swimming • 5- Exercise bicycle • 6- Road cycling • 7- Dynamic proprioceptive exercises • 8-Start running Begin a gradual return to running. Once the athlete can run for 20 to 30 minutes without any problems then speed work can be gradually introduced Start at 50% of maximum speed and increase each session to 90% of maximum speed. Include backwards and sideways running drills as well as quick changes of direction.

  8. Fifth Stage (90th Day Onwards) • Aims • 1- regain full strength • 2- begin to return to sports specific training • 3- return to sports specific training and competition

  9. Fifth Stage (90th Day Onwards) • 1- Resumption of training • 2- Plyometric exercises (hopping and bounding possible during this stage). • 3- Sprinting speed should now be near to normal and the athlete able to change direction at speed and • Normal sports specific training should now be resumed. • 3- gradual return to specific sport footballer may play only 20 minutes of a game.

  10. Safely return to your sport or activity • when, starting from the top of the list and progressing to the end, each of the following is true:1-have full range of motion in the injured knee compared to the uninjured knee. 2- have full strength of the injured knee compared to the uninjured knee. 3- can jog straight ahead without pain or limping. 4- can sprint straight ahead without pain or limping. 5- can do 45-degree cuts, first at half-speed, then at full-speed. 6- can do 20-yard figures-of-eight, first at half-speed, then at full-speed. 7- can do 90-degree cuts, first at half-speed, then at full-speed. 8- You can do 10-yard figures-of-eight, first at half-speed, then at full-speed. 9- You can jump on both legs without pain and you can jump on the injured leg without pain.

  11. Surgical treatment • Surgery to reconstruct a PCL-deficient knee is most often indicated with avulsion injuries. • Young subjects with severe laxity, clinically significant instability and radiographical evidence of a posterior tibial translation exceeding 10 mm should be reconstructed when the onset of degeneration is foreseen • Reconstructive procedures using the semitendinous tendon, the tendon of the medial gastrocnemius, the Achilles tendon, the patellar tendon, or synthetic material to replace the lost PCL have been recommended.

  12. Ligamentisation is less successful than after ACL re­construction for three reasons: • (1) posterior translation of the tibia due to the force of gravity • (2)overstretching of the new ligament by the flexors • (3) the slant of the femoral and tibial graft tunnel, especially the latter.

  13. Rehabilitation After Reconstruction of an Isolated PCL Tear • Rehabilitation thus requires: • 1- Immobilization and bed rest • 2- Recovery of range of motion (ROM) • 3- Regain of weight bearing • 4- Muscle strengthening • 5- Proprioceptive exercises

  14. First Stage (First 15 Days After Surgery) • 1. Knee brace locked in extension with pillow under triceps during bed rest • 2. CPM set between 0° and 900. Mobilization is begun from 0° to 40°, 48 h after surgery and gradually increased over the next few days • 3- Isometric exercises for the quadriceps (patient supine) and glutei (patient prone) • 4- Partial weight-bearing with walkers and brace locked in extension

  15. Second Stage (15th-30th Day) • 1-Knee brace locked in extension with pillow under triceps during bed rest • 2-Gradual attainment of full weight bearing • 3-Electrotherapy of the quadriceps • 4- Knee flexion by physiotherapist to reach 0°-90° • 7- Isometric exercises for quadriceps and all lower-limb muscles except knee flexors • 8-Semi-squat • 9- Closed-chain proprioceptive exercises

  16. Third Stage (30th - 60th Day) • 1- ROM attained must be 0°-90° • 2- Removal of brace and pillow under triceps during bed rest • 3- Abandonment of walkers if good quadriceps control achieved • 4- Brace articulated at 0°-1200 for another 2 weeks • 5- Electrotherapy of the quadriceps • 6- Knee flexion by physiotherapist • 7- Isometric exercises for all lower-limb muscles • 8- Semi-squat • 9- Closed-chain proprioceptive exercises

  17. Fourth Stage (60th-90th Day) • 1-ROM obtained must be complete • 2-Isometric gymnastics continued • 3-Tapis roulant • 4-Swimming. Avoid knee flexion • 5-Exercise bicycle with high saddle and foot forward on pedal to minimize knee flexion • 6-Semi-squat • 7-Horizontal leg-press • 8- Proprioceptive exercises

  18. Fifth Stage (3rd-6th Month) • 1-Swimming • 2-Exercise and ordinary bicycle • 3-Leg press • 4-Stairs climber • 5-Start running • 6-Start of active work for flexors • 7-Proprioceptive exercises

  19. Sixth Stage (6th - 8th Month) • 1-Bicycle • 2-Running • 3-Running uphill • 4-Vertical jumps • 5-Isokinetics • 6-Dynamic proprioceptive exercises

  20. Seventh Stage (8th -10th Month) • Resumption of sport, including contact sport

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