Disagreement Persists on Optimal Rehabilitation Goals and Timelines for Weight-Bearing Restriction, Knee Brace Use, and Return to Sports After Posterolateral Corner Reconstruction

Abstract

Purpose

To assess the variability of rehabilitation protocols for both isolated posterolateral corner (PLC) reconstructions and those with a concomitant anterior cruciate ligament (ACL)/posterior cruciate ligament (PCL) reconstruction, to construct uniform rehabilitative protocol recommendations, and to propose rehabilitative outcome measures for future PLC-related clinical studies.

Methods

A Google search was conducted for online PLC reconstruction rehabilitation protocols, categorizing them into isolated PLC reconstructions or PLC with concomitant ACL/PCL reconstructions. Rehabilitative goals and timelines were described and agreement rates among protocols were calculated. Comparisons were made between groups and before/after 2019, when a global consensus was published. Common rehabilitative goals with high agreement rates were used to form a recommended protocol.

Results

Thirty-seven protocols were analyzed (19 isolated PLC, 9 PLC + PCL, and 9 PLC + ACL). Overall, 31% of rehabilitative goals and timelines had good-to-excellent agreement rates. Post-2019 consensus, adherence to a stepwise rehabilitative approach significantly improved, especially for initiating strength exercises after muscular endurance exercises (P = .009) and initiating power exercises after strength exercises (P = . 031). However, there was no significant change in overall agreement rates (P = . 735). Most disagreements involved postoperative weight-bearing restrictions, with one half of protocols recommending non−weight-bearing and one half partial-weight-bearing; the period of time a knee brace is required after 6 weeks; and return to sports timing, which differed with concomitant ACL (later return) and PCL (earlier return) reconstructions.

Conclusions

There is disagreement about optimal rehabilitative goals and timelines for weight-bearing restriction, knee brace use, and return to sports after PLC reconstructions. Rehabilitative outcomes that warrant further research were identified, and a suggested rehabilitation protocol was constructed.

Clinical Relevance

Rehabilitation after PLC reconstruction lacks standardization, with significant variation in key milestones such as weight-bearing, knee bracing, and return-to-sport timelines. This study provides an analysis of current rehabilitation protocol inconsistencies and offers a structured recommendation that may assist clinicians and physiotherapists in patient counseling and protocol development.