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This protocol is intended to guide clinicians through the post-operative course for MPFL reconstruction. This protocol is time based (dependent on tissue healing) as well as criterion based.
This evidence-based MPFL reconstruction rehabilitation protocol is criterion-based; time frames and visits in each phase will vary depending on many factors- including patient demographics, goals, and individual progress.
The following rehabilitation guidelines and protocol are developed for patients who have undergone MPFL (medial patellofemoral ligament) reconstruction for patellar (kneecap) instability. Any patients who also underwent a bone realignment procedure will have a different protocol.
Phase 1 (0-6 weeks post op): Goals. Protect Repair. Control post-operative pain, inflammation, and swelling. Prevent muscle atrophy – regain active quadriceps contraction. Brace/Precautions/ Crutch Use. Weight bearing: 0-2 weeks: 50% weight-bearing.
The medial patellofemoral ligament (MPFL), a continuation of the Vastus Medialis Oblique (VMO) muscle fibers, extends from the superior inner side of the patella to the medial femur and helps prevent lateral displacement of the patella during the first 20 o-30o of knee flexion.
Improve range of movement with active knee flexion and extension. Strengthen quadriceps: static quadriceps contraction, straight leg raise (with no weight), inner and through range strengthening. Mobilise with crutches weight bearing as tolerated. Stitches removed at approximately 10 days.
Recommended Criteria and Parameters for BFR: Minimum 2 weeks post op pending incision healing, no red flags, can complete in conjunction with NMES (SLR). Utilize with low intensity CKC loading start with body weight, no greater than 30% 1RM.
Progress to normal gait pattern, gastroc/soleus stretch, begin toe raises, closed chain extension, balance exercises, hamstring curls, and stationary bike. Advance closed chain strengthening, progress proprioception activities, begin Stairmaster/Nordic Trac and running straight ahead.
Rehabilitation Medicine: (603) 650-3600. Phase I: 0-6 weeks. Restrictions: Weight Bearing and brace use: 0 – 2 weeks: WBAT with crutches and Bledsoe brace locked in full extension. 2 – 6 weeks: WBAT progressing from crutches as able (no limp and no lag). Brace: Transition to PTO brace at 2 weeks post op.
Varying surgical techniques exist for performing a MPFL reconstruction with multiple autograft choices available—including but not limited to hamstring tendon, adductor magnus tendon, vastus medialis obliquus, or quadriceps tendon8,9. Allograft tissue has also been utilized with some success8.
