Posterior cruciate ligament tears: functional and postoperative rehabilitation.

PURPOSE: Historically, the results of posterior cruciate ligament (PCL) reconstructions are not as favourable as anterior cruciate ligament (ACL) reconstructions, and it is well recognized that nonoperative treatment and postoperative rehabilitation for PCL injuries must be altered compared to those for ACL injuries. The purpose of this article was to review current peer-reviewed PCL rehabilitation programmes and to recommend a nonoperative and postoperative programme based on basic science and published outcomes studies.

METHODS: To discover the current practices being used to rehabilitate PCL injuries, we conducted a search of PubMed with the terms "posterior cruciate ligament" and "rehabilitation" from 1983 to 2011. All articles within the reference lists of these articles were also examined to determine their rehabilitation programmes.

RESULTS: A review of peer-reviewed PCL rehabilitation protocols revealed that the treatment of PCL injuries depends on the timing and degree of the injury. Rehabilitation should focus on progressive weight bearing, preventing posterior tibial subluxation and strengthening of the quadriceps muscles. General principles of proper PCL rehabilitation, whether nonoperative or postoperative, should include early immobilization (when necessary), prone passive range of motion to prevent placing undue stress on grafts or healing tissue, and progression of rehabilitation based on biomechanical, clinical, and basic science research.

CONCLUSIONS: An optimal set of guidelines for the nonoperative or postoperative management of PCL injuries has not yet been defined or agreed upon. Based on the current review study, suggested guidelines are proposed.

LEVEL OF EVIDENCE: IV.