Post-operative rehabilitation following posterior cruciate ligament reconstruction on manual labourer
DOI:
https://doi.org/10.18203/2320-6012.ijrms20253199Keywords:
PCL reconstruction, Knee rehabilitation, Quadriceps strengthening, Knee stability, Gait trainingAbstract
Injuries to the posterior cruciate ligament (PCL) are less common than injuries to the anterior cruciate ligament (ACL), but they make the knee much less stable and functional. Post-operative complications such as stiffness, muscle inhibition, and gait dysfunction often require an intensive and structured rehabilitation program. This case study highlights the role of comprehensive physiotherapy following delayed PCL reconstruction and medial meniscus repair. A 32-year-old male was done with imaging after his motorcycle accident, it revealed that a near-complete PCL tear, medial meniscus tear. He underwent arthroscopic PCL reconstruction and meniscus repair followed by 3 months immobilized in a brace at 30-degree flexion. After that the patient came with a complaint of a swelling, reduced range of motion (ROM), muscle wasting, inability to flex or extend his left knee. The patient went through a 12-week rehab program that included manual therapy, electrotherapy (faradic and Russian current), progressive strength training, gait training, and cryotherapy. Significant improvements were recorded over 12 weeks: pain reduced from 8/10 to 2/10 numerical pain rating scale (NPRS), active knee flexion improved from 40° to 128°, extensor lag resolved from 27° to 0°, and IKDC score increased from 40.2%/100% to 85.1%/100%. Muscle strength across the quadriceps, hamstrings, and gluteal muscles also showed notable gains while achieving all the short- and long-term goals. This case illustrates the importance of delayed referral, week-wise rehabilitation, and individualized physiotherapy for optimal recovery following PCL reconstruction. The integration of neuromuscular stimulation, targeted strengthening, and functional re-training proved effective in restoring joint mechanics and return to daily activities. Delayed mobilization and immobilization complications underscore the need for timely, evidence-based rehabilitation protocols.
Metrics
References
Sonnery-Cottet B, Ripoll T, Cavaignac E. Prevention of knee stiffness following ligament reconstruction: Understanding the role of Arthrogenic Muscle Inhibition (AMI). Orthop Traumatol Surg Res. 2024;110(1):103784. DOI: https://doi.org/10.1016/j.otsr.2023.103784
Senese M, Greenberg E, Lawrence JT, Ganley T. Rehabilitation following isolated posterior cruciate ligament reconstruction: a literature review of published protocols. Int J Sports Physical Ther. 2018;13(4):737. DOI: https://doi.org/10.26603/ijspt20180737
Halawar RS. Magnetic Resonance Imaging Study of Types and Incidence of Injuries in Traumatic Knee Joint (Doctoral dissertation, Rajiv Gandhi University of Health Sciences (India)).
Monitari T, Supriyadi A, Mardianto H. Physiotherapy Management for Post Reconstruction Posterior Cruciate Ligament Acute Phase: A Case Study. In Academic Physiotherapy Conference Proceeding. 2021.
Memmel C, Koch M, Szymski D, Huber L, Pfeife r C, Knorr C, et al. Standardized rehabilitation or individual approach? a retrospective analysis of early rehabilitation protocols after isolated posterior cruciate ligament reconstruction. J Personal Med. 2022;12(8):1299. DOI: https://doi.org/10.3390/jpm12081299
Alghadir AH, Anwer S, Iqbal A, Iqbal ZA. Test–retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. J Pain Res. 2018:851-6. DOI: https://doi.org/10.2147/JPR.S158847
Higgins LD, Taylor MK, Park D, Ghodadra N, Marchant M, Pietrobon R, Cook C. Reliability and validity of the International Knee Documentation Committee (IKDC) subjective knee form. Joint Bone Spine. 2007;74(6):594-9. DOI: https://doi.org/10.1016/j.jbspin.2007.01.036
Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. FA Davis. 2016.
Conroy VM, Murray Jr BN, Alexopulos QT, McCreary J. Kendall's muscles: testing and function with posture and pain. Lippincott Williams and Wilkins. 2022.
Bakar Y, Özdemir ÖC, Sevim S, Duygu E, Tuğral A, Sürmeli M. Intra-observer and inter-observer reliability of leg circumference measurement among six observers: a single blinded randomized trial. J Med Life. 2017;10(3):176.
Snyder-Mackler L, Delitto A, Bailey SL, Stralka SW. Strength of the quadriceps femoris muscle and functional recovery after reconstruction of the anterior cruciate ligament. A prospective, randomized clinical trial of electrical stimulation. JBJS. 1995;77(8):1166-73. DOI: https://doi.org/10.2106/00004623-199508000-00004
Simhal RK, Bovich M, Bahrun EA, Dreese JC. Postoperative rehabilitation of posterior cruciate ligament surgery: a systematic review. Sports Med Arthroscopy Rev. 2021;29(2):81-7. DOI: https://doi.org/10.1097/JSA.0000000000000307
Kew ME, Cavanaugh JT, Elnemer WG, Marx RG. Return to play after posterior cruciate ligament injuries. Cur Rev Musculosk Med. 2022;15(6):606-15. DOI: https://doi.org/10.1007/s12178-022-09794-z
Reiman MP, Bolgla LA, Loudon JK. A literature review of studies evaluating gluteus maximus and gluteus medius activation during rehabilitation exercises. Physiother Theory Pract. 2012;28(4):257-68. DOI: https://doi.org/10.3109/09593985.2011.604981
de Castro MP, de Brito Fontana H, Fóes MC, Santos GM, Ruschel C, Roesler H. Activation of the gluteus maximus, gluteus medius and tensor fascia lata muscles during hip internal and external rotation exercises at three hip flexion postures. J Bodywork Movement Therap. 2021;27:487-92. DOI: https://doi.org/10.1016/j.jbmt.2021.05.011
Lehecka BJ, Edwards M, Haverkamp R, Martin L, Porter K, Thach K, et al. Building a better gluteal bridge: electromyographic analysis of hip muscle activity during modified single-leg bridges. Int J Sports Phys Ther. 2017;12(4):543.
Reid DA, Kim J. The frequency of hamstring stretches required to maintain knee extension range of motion following an initial six-week stretching programme. N ZealJ Physiot. 2014;42(1):22-7.
John RF, Wang YE, Wu YC, Chen WL, Hsueh TC. Electrical Stimulation versus Conventional Exercise in Strengthening Quadriceps After Lower Leg Injury. Rehabil Pract Sci. 1995;23(2):129-34. DOI: https://doi.org/10.6315/3005-3846.1954
Kim JG, Lee YS, Yang BS, Oh SJ, Yang SJ. Rehabilitation after posterior cruciate ligament reconstruction: a review of the literature and theoretical support. Arch Orthop Trauma Surg. 2013;133:1687-95. DOI: https://doi.org/10.1007/s00402-013-1854-y
Cury RD, Kiyomoto HD, Rosal GF, Bryk FF, de Oliveira VM, de Camargo OP. Rehabilitation protocol after isolated posterior cruciate ligament reconstruction. Rev Brasileira de Ortopedia. 2012;47(4):421-7. DOI: https://doi.org/10.1590/S0102-36162012000400003
Lu CC, Yao HI, Fan TY, Lin YC, Lin HT, Chou PP. Twelve weeks of a staged balance and strength training program improves muscle strength, proprioception, and clinical function in patients with isolated posterior cruciate ligament injuries. Int J Environ Res Pub Health. 2021;18(23):12849. DOI: https://doi.org/10.3390/ijerph182312849
Escamilla R, Zheng NA, Macleod T, Brent Edwards W, Imamura R, Hreljac A, Fleisig G, Wilk K, Moorman C, Andrews J. Patellofemoral joint force and stress during the wall squat and one-leg squat. Medicine+ Science in Sports+ Exercise. 2009;41(4):879. DOI: https://doi.org/10.1249/MSS.0b013e31818e7ead
LaPrade RF, Johansen S, Engebretsen L, Wentorf FA, Engebretsen AH. Return to play after posterior cruciate ligament injuries. Clin Sports Med. 2015;34(1):179-87.
Pierce CM, O’Brien L, Griffin LW, LaPrade RF. Posterior cruciate ligament tears: functional and postoperative rehabilitation. Knee Surgery, Sports Traumatology, Arthroscopy. 2013;21:1071-84. DOI: https://doi.org/10.1007/s00167-012-1970-1