KNEE Posterior cruciate ligament tears: functional and postoperative rehabilitation Casey M. Pierce • Luke O’Brien • Laurie Wohlt Griffin • Robert F. LaPrade Received: 8 November 2011 / Accepted: 12 March 2012 / Published online: 8 April 2012 Ó Springer-Verlag 2012 Abstract 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 postop- erative 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 rehabili- tation 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 Pub- Med 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 mus- cles. 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 biome- chanical, clinical, and basic science research. Conclusions An optimal set of guidelines for the non- operative 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. Keywords PCL Á Treatment Á Nonoperative rehabilitation Á Postoperative rehabilitation Á Guidelines Introduction Unlike the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL) has an intrinsic ability to heal and may regain continuity following an injury; however, in a PCL-deficient knee, gravity and the forces on the joint from the hamstring muscles can potentially cause the tibia to be positioned in a posteriorly subluxed location relative to the femur [17, 25, 29, 44–47, 49]. Healing of the PCL in an elongated position can lead to chronic instability and disability [46]. The use of a cylindrical cast, which applies an anterior drawer force, has demonstrated that placing the PCL in a properly reduced position, with less posterior sag, allows for improved healing [26]. Patients who have undergone surgical reconstruction of the PCL commonly report residual posterior laxity, especially following treat- ment of chronic tears [2, 27, 43, 54]. Numerous studies have investigated rehabilitation pro- tocols for patients following ACL reconstruction, but unfortunately the same cannot be said for patients with a C. M. Pierce Steadman Philippon Research Institute, Vail, CO, USA L. O’Brien Á L. W. Griffin Howard Head Sports Medicine Center, Vail, CO, USA R. F. LaPrade (&) The Steadman Clinic, 181 W. Meadow Drive, Suite 400, Vail, CO 81657, USA e-mail: drlaprade@sprivail.org 123 Knee Surg Sports Traumatol Arthrosc (2013) 21:1071–1084 DOI 10.1007/s00167-012-1970-1