Guidelines: Post-Operative Elbow Lateral Collateral Ligament Reconstruction (with autograft or synthetic graft)


Dr Tanya Mackenzie PhD

Specialist Upper Limb Physiotherapist, Manchester Shoulder Clinic


Maximum Protection (0 to 14 Days)

Control swelling in wrist & hand

Immobilization in sling for 6 weeks

Wound care

AROM wrist & fingers

AAROM & AROM elbow flex & ext with patient lying supine, shoulder flexed to 90 degrees

AROM Pro/supination with elbow in 90 flexion

Do not force supination


Progressive ROM & introduction to light isometrics (2 to 6 Weeks)

Finger & Wrist isometrics

Increase AAROM & AROM elbow flexion & extension as tolerated

Short lever scapular & kinetic chain rehab

Light proprioceptive exercises

(Week 4) isometric elbow flexion & extension (Isometric anconeus)

Maintain shoulder AROM with flexed elbow

Do not force supination – Active supination done in 90° elbow flexion

CKC work to be feather weight bearing in full pronation

No forced movements – active motions done as tolerated

Avoid full elbow extension combined with supinated forearm


Progressive ROM & introduction to strength program (6 weeks)

Full kinetic chain rehab with UL short lever initially progressing to long lever

Assess shoulder biomechanics & address

Isotonic strengthening program elbow & shoulder & forearm

CKC gradually increasing weight bearing

Avoid varus elbow load (long lever in abduction)



Progressive strengthening & return to function (Week 8)

Maintain full elbow ROM

Introduce light activity/sport specific activities

Initiate eccentric elbow activity

Introduce diagonal PNF patterns

Introduce plyometrics

Continue to strengthening elbow & shoulder


Time scales

Full AROM – 6 weeks

Begin a general strengthening program in the gym with slow, light loads– 16 weeks

Return to work guidelines:

❏ Light sedentary: 6 weeks.

❏ Heavy Manual: 12 weeks.

Sport: depends on the sport your consultant & physio will advise

May return to unrestricted activity at one year

Download here – guidelines-lat-lig-recon-elbow