Medial Collateral Ligament Rehabilitation Protocol

The primary goal of this protocol is to protect the reconstruction site while steadily progressing towards pre-injury level of activity. Strict adherence to rehabilitation protocols is essential to enable optimal healing. Please note this protocol is a guideline. Achieving the criteria of each phase is more important than the approximate duration.

PHASE I: 0-2 WEEKS POSTOPERATIVE

GOALS:

• Protect healing tissue from load and shear

• Decrease Pain and Swelling

• Regain full passive knee extention

• Regain quad control

WALKING AND BRACE USE:

Brace x 8 weeks – Locked in extension for walking

Crutches – Partial weight bearing (PWB) in brace (no more than 50% of body weight)

EXERCISES:

Calf pumping every hour for circulation

Keep leg up, wear compression bandage and to ice knee for 15-20 minutes at least 4-5 times per day

Hamstrings stretch in long sit

Knee cap mobilisation

Short arc quads

Quad and Glute sets in supine

Straight leg raise (SLR) x 3 in locked brace - No ADD

Calf stretch

No stationary bike x 6 weeks

Ice pack with knee in full extension after exercise

PHASE II: ~2-4 WEEKS POSTOPERATIVE

GOALS:

• ROM 0-90 degrees

• No extensor lag

WALKING AND BRACE USE:

Brace x 8 weeks – Open to 0-45 degrees

Crutches – PWB in brace

EXERCISES:

Continue appropriate previous exercises

Scar massage when incision healed

AAROM, AROM 0-90 degrees only

Passive knee flexion to 90 degrees (push up with opposite leg)

SLR x 3 on mat, no brace if good quad control - No ADD

Double leg heel raises

No stationary bike x 6 weeks

Stretches – Hamstring, Hip Flexors, ITB

PHASE III: ~4-6 WEEKS POSTOPERATIVE

GOALS:

• ROM 0-120 degrees

• No effusion

WALKING AND BRACE USE:

Brace x 8 weeks – Open to 0-90 degrees

Crutches – PWB in brace

EXERCISES:

Continue appropriate previous exercises

Scar massage for mobility

AAROM, AROM 0-120 degrees

Standing SLR x 3 with light resistance band bilaterally – May begin Hip ADD with resistance band if good LE control in full extension

Mini squats 0-45 degrees

Passive knee flexion to 90 degrees (push up with opposite leg) 

Leg press 0-45 degrees with resistance up to ¼ body weight

Hamstring curls 0-45 degrees – Carpet drags or rolling stool (closed chain) 

No stationary bike x 6 weeks

PHASE IV: ~6-8 WEEKS POSTOPERATIVE

GOAL:

Full ROM

WALKING AND BRACE USE:

Brace – Open to full range

Crutches - Weight bearing as tolerated(WBAT),

D/C crutch when gait is normal

EXERCISES:

Continue appropriate previous exercises PROM,

AAROM, AROM to regain full motion

Standing SLR x 4 with light resistance band bilaterally

Wall squats 0-45 degrees Leg press 0-60 degrees with resistance up to ½ body weight

Hamstring curls through full range – Carpet drags or rolling stool

Forward, lateral and retro step downs in parallel bars – No knee flexion past 45 degrees (small step)

Proprioceptive training – Single leg standing in parallel bars –

Double leg BAPS for weight shift

Single leg heel raises

Treadmill – Forwards and backwards walking

Stationary bike – Progressive resistance and time

Elliptical trainer

PHASE V: ~8-12 WEEKS POSTOPERATIVE

GOAL:

Walk 3 km at a gentle pace

BRACE USE:

Stop brace when full quads control

EXERCISES:

Continue appropriate previous exercises with progressive resistance

Leg press 0-90 degrees with resistance as tolerated

Hamstring curls on weight machine

Knee extension weight machine

Forward, lateral and retro step downs (medium to large step)

Proprioceptive training – Single leg BAPS, ball toss and body blade – Grid exercises

Treadmill – Walking progression program

Stairmaster – Small steps

Pool therapy

PHASE VI: ~3-4 MONTHS POSTOPERATIVE

GOAL:

Run 3 km at an easy pace

EXERCISES:

Continue appropriate previous exercises

Step down

BOSU mini-squats (0-30 degrees)

Physioball wall squats or wall squats (0-60 degrees)

Physioball one legged bridge with knee extended

Physioball two legged curl for hamstrings

Functional activities – Figure 8s, gentle loops, large zigzags

Treadmill – Running progression program

Pool therapy – Swimming laps

Quad stretches

PHASE VII: ~4-6 MONTHS POSTOPERATIVE

GOAL:

Return to all activities

EXERCISES:

Begin hamstring curl machine 

Lateral shuffle with band

Monster walk with band

Airex box drill with band for 4 way hip

Cone reach with knee straight

Cone reach with knee bent slightly

Forward lunge (limited range of motion)

Do not do lateral lunge

CRITERIA TO START RUNNING/AGILITY PROGRAM

No contact sports until 6 months post-op

No pain, crepitus, edema or giving way

Normal stability with valgus stress test

Muscle strength at least 5/5

ROM equal to uninvolved side or at least 0-125 

Normal gait pattern at least 20 minutes without symptoms

Leg Press test within 75-80% of contralateral leg

Hamstring and quadricep strength 70 % of the involved side isokinetically

Lateral step test within 75-80% of contralateral leg

Clearance from surgeon

References:

University Orthopaedics, Inc

Dr Glen McLung: Beacon Orthopaedics and Sports Medicine

Logan CA, O'Brien LT, LaPrade RF. POST OPERATIVE REHABILITATION OF GRADE III MEDIAL COLLATERAL LIGAMENT INJURIES: EVIDENCE BASED REHABILITATION AND RETURN TO PLAY. Int J Sports Phys Ther. 2016 Dec;11(7):1177-1190.