Integrated rehabilitation incorporating aquatic therapy following posterior cruciate ligament reconstruction: a case report

INTRODUCTION: Rehabilitation following posterior cruciate ligament (PCL) reconstruction can be challenging because of improper muscle activation and excessive joint loading which could further delay graft healing. Aquatic therapy provides a buoyancy-assisted aquatic environment, where reduced effective body weight and joint loading may facilitate early functional recovery while minimizing stress on the reconstructed ligament. However, evidence regarding aquatic rehabilitation following PCL reconstruction remains limited. CASE DESCRIPTION: A 51-year-old woman presented for physiotherapy 4 weeks after arthroscopic reconstruction of right PCL avulsion injury. The patient reported knee pain, limited range of motion, trouble climbing stairs, walking and difficulties with functional activities. Clinical examination demonstrated quadriceps weakness, antalgic gait, reduced balance, and limited knee mobility. A structured 4-week rehabilitation program combining aquatic physiotherapy and land-based (given for first week only) was implemented 5 sessions per week. OOUCOMES: Following 4 weeks of rehabilitation, knee flexion ROM improved by 35° (41.2%) and full knee extension was restored. Lower-limb muscle strength increased across all muscle groups, with the greatest gain observed in quadriceps strength (75.8%). Dynamic balance improved substantially, with SEBT reach distances increasing by 22-25 cm (42-49%). Patient-reported outcomes demonstrated clinically meaningful improvement, with KOOS subscale scores increasing by 25-34 points, exceeding the established MCID of 8-10 points. These findings indicate substantial improvements in knee mobility, strength, balance, and function. CONCLUSION: Early integration of aquatic therapy following PCL reconstruction was a safe and effective adjunct to conventional physiotherapy rehabilitation. The supportive aquatic environment facilitated improvements in pain, mobility, muscle strength, balance, and functional outcomes while maintaining graft protection.