Delayed Initiation of Structured Rehabilitation After Posterior Cruciate Ligament Reconstruction in a Competitive Sprinter: A Case Report
Abstract
Background: Rehabilitation after posterior cruciate ligament reconstruction (PCLR) requires a balance between protection of the healing graft and progressive restoration of knee motion, quadriceps function, neuromuscular control, and sportspecific capacity. Delayed initiation of structured rehabilitation may complicate recovery when postoperative stiffness and muscle inhibition are already established. Case presentation: A 25-year-old male competitive 100-m sprinter sustained a full-thickness posterior cruciate ligament (PCL) tear with a grade 2 anterior cruciate ligament sprain and grade 2 medial meniscal tear following a motor vehicle accident. Arthroscopic PCL reconstruction was performed. Structured physiotherapy was not initiated for approximately six weeks, by which time knee flexion was limited to about 45°. Manipulation under anaesthesia was subsequently performed, after which a 12-week structured rehabilitation programme was commenced. Intervention: Rehabilitation was progressed in three phases. Early management emphasized swelling and pain control, restoration of knee motion, quadriceps activation, gait retraining, and avoidance of isolated resisted hamstring loading. Intermediate rehabilitation introduced closed-kinetic-chain strengthening and progressive functional loading. The final phase incorporated advanced strengthening, dynamic balance, conditioning, and graded running-related activities. Outcomes : At rehabilitation baseline, active knee flexion was 60°, passive flexion 70°, and extension lag 15°. Quadriceps and hamstring strength were 3+/5 and 3-/5, respectively, and the patient was unable to complete dynamic functional tests. By week 12, active flexion had increased to 135°, passive flexion to 140°, and extension lag had resolved. Manual muscle testing was 5/5 for both quadriceps and hamstrings. Quadriceps tendon pain decreased from 7/10 to 1/10 and patellar tendon pain from 6/10 to 0/10. The 1-minute squat test improved from inability to perform the test to 48 repetitions. Stork balance time reached 110 seconds on the involved limb. Limb girth improved substantially, although small residual asymmetry remained. Modified Star Excursion Balance Test limb symmetry indices were 94% anteriorly, 75% posteromedially, and 82% posterolaterally at discharge. Conclusion: Marked gains in knee motion, strength, gait, pain, and functional performance were observed during 12 weeks of structured rehabilitation initiated after postoperative stiffness had developed. The case supports the feasibility of substantial functional recovery despite delayed rehabilitation, but it does not establish treatment efficacy or readiness for unrestricted competitive sprinting. Residual dynamic-balance asymmetry and the absence of longer-term return-to-sport data warrant continued rehabilitation and objective reassessment.
Keywords:
Athlete; Posterior cruciate ligament; PCL reconstruction; Rehabilitation; Return to sport; SprinterDownloads
Published
Issue
Section
License
Copyright (c) 2026 Brijesh Vishwakarma,, Suvarna Ganvir, Kabir Ghai (Author)
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The journal allows authors to retain copyright without restrictions and retains unrestricted publishing rights.
The submitted papers are assumed to contain no proprietary material unprotected by patent or patent application; responsibility for technical content and for protection of proprietary material rests solely with the author(s) and their organisations and is not the responsibility of the journal. The main (first/corresponding) author is responsible for ensuring that the article has been seen and approved by all the other authors. It is the responsibility of the author to obtain all necessary copyright release permissions for the use of any copyrighted materials in the manuscript before submission.
What are my rights as an author?
It is important to check the policy for the journal to which you are submitting or publishing to establish your rights as
Author. Journal's standard policies allow the following reuse rights:
- The journal allows the author(s) to hold the copyright without restrictions.
- The journal allows the author(s) to obtain publishing rights without restrictions.
- You may do whatever you wish with the version of the article you submitted to the journal.
- Once the article has been accepted for publication, you may post the accepted version of the article on your own personal website, your department's website or the repository of your institution without any restrictions.
- You may not post the accepted version of the article in any repository other than those listed above (i.e. you may not deposit in the repository of another institution or a subject-matter repository) until 12 months after publication of the article in the journal.
- You may use the published article for your own teaching needs or to supply on an individual basis to research colleagues, provided that such supply is not for commercial purposes.
