MPFL Reconstruction Rehab

Guidelines/Precautions

  • No closed-kinetic chain exercises for 6 weeks
  • Same rehab protocol is followed for proximal and distal procedures except weight-bearing and other limitations as noted
  • After combined proximal and distal realignment, the protocol for distal realignment is used

 

Phase I (1 – 5 days post-op)

Wound care:Observe for signs of infection

Modalities: Ice for pain and inflammation

Brace

  • Locked in full extension for all activities except therapeutic exercises and CPM use
  • Locked in full extension for sleeping

Gait

  • WBAT with two crutches for proximal realignment procedure
  • 50% weight bearing with two crutches for distal realignment

ROM

  • 0 – 30 degrees of flexion
  • Ankle A ROM

Strengthening:none

 

Phase II (5 days – 4 weeks post-op)

Wound care: Monitor site for signs of infection and initiate scar management techniques when incision closed

Modalities: Ice PRN for pain and inflammation

Brace:

  • 0-4 weeks locked in full extension for all activities except therapeutic exercises and CPM use
  • Locked in full extension for sleeping

Gait:

  • WBAT with two crutches for proximal realignment procedure
  • 50% weight bearing with two crutches for distal realignment
  • ROM
  • 0 – 2 weeks: 0 – 30 degrees of flexion
  • 2 – 4 weeks: 0 – 60 degrees of flexion
  • Goal of full knee extension by week 6

Strengthening:

  • Quad sets for isometric adduction with biofeedback and E-stim for VMO (no E-stim for 6 weeks for proximal realignment). Goal of regaining active quad and VMO control by end of 6 weeks.
  • Heel slides from 0 – 60 degrees of flexion for proximal realignment, 0 – 90 degrees of flexion for distal realignment
  • CPM for 2 hr, bid from 0 – 60 degrees of flexion for proximal realignment, 0 – 90 degrees of flexion for distal realignment
  • NWB gastroc, soleus, and hamstring stretches
  • SLR in four planes with brace locked in full extension lying down or standing
  • Resisted ankle ROM with Theraband
  • Patellar mobilization (begin as tolerated)
  • Begin aquatic therapy at 3 – 4 weeks, emphasis on gait

 

Phase III (4 – 10 weeks post-op)

Wound care:Observe for signs of infection, continue scar mobs

Modalities: Continue ice prn for pain and inflammation

 

4weeks to 6 weeks:

Brace:Unlocked for sleeping, locked in full extension for ambulation

Gait

  • WBAT with two crutches for proximal realignment procedure
  • 50% weight bearing with two crutches for distal realignment

ROM:0 – 90 degrees of flexion

Strengthening:continue same as phase II

 

6 weeks to 8 weeks:

Brace:Discontinue use for sleeping, unlock for ambulation as allowed by physician

Gait:As tolerated with two crutches

ROM:Increase flexion gradually to normal range for patient

Strengthening:

  • Continue exercises progressing to full flexion with heel slides
  • Progress to weight-bearing gastroc, soleus stretching
  • Continue aquatic therapy
  • Closed chain balance exercises
  • Stationary bike, low resistance, high-seat
  • Wall slides progressing to mini-squats, 0-45 degrees of flexion

 

8 weeks to 10 weeks

Brace:D/C

Gait:May D/C crutches if no extension lag is present, patient is able to achieve full extension, and gait pattern is normalized with one crutch.

Strengthening:

  • Should be able to demonstrate SLR without extension lag
  • May begin closed chain strengthening including step-ups (begin at 2 inch step)
  • Moderate resistance for stationary bike
  • Four way resisted hip strengthening
  • Leg press for 0-45 degrees of flexion
  • Swimming and/or stairmaster for endurance
  • Toe raises, hamstring curls and proprioceptive exercises
  • Treadmill walking
  • Flexibility exercises continued

 

Phase IV (10+ weeks post-op)

Criteria for return to play:

  • Clearance from physician to begin more concentrated closed-kinetic chain exercises and resume full or partial activity level
  • At least 0 – 115 degrees AROM with no swelling and complete voluntary contraction of quad
  • No evidence of patellar instability
  • No soft tissue complaints

Strengthening:

  • Progression of closed-kinetic chain activities including partial squats (60 degrees), leg press, forward and lateral lunges, lateral step-ups, leg extensions 60 – 0 degrees, bicycle and /or stepper.
  • Functional progression, sport specific activities
  • Functional testing: Performance to < 25% deficit compared to non-surgical side by D/C