MPFL Reconstruction — Medial Patellofemoral Ligament Reconstruction

Children's Hospital of Philadelphia (CHOP) · Dr. Theodore Ganley MD; Dr. Kathleen Maguire MD; Dr. Brendan Williams MD; Dr…

Weight-Bearing

TTWB with crutches wks 1-2; WBAT wean crutches wk 2; brace locked full extension (-10 deg on brace) at all times except PROM exercises; sleep in brace locked

Key Restrictions

Brace locked extension at all times wks 1-2 (incl sleep); increase flex 10 deg/day Phase I (CPM if available: start 30 deg, increase 10 deg/daily); brace unlocked to 90 deg for ambulation at wk 4 if SLR without lag and AROM >=90 deg; sleep in locked brace until full extension is consistent; D/C brace at 6 wks if AROM >=100 deg and single-leg squats to 30 deg with good frontal plane control; squats, wall sits and leg press <=90 deg flexion until 8 wks; no lateral patellar mobilizations; surgeon clearance required at 3, 6, and 9 months to progress; return to full activity at 9 months if all criteria met; earlier return to sport per surgeon based on performance

Timeline & Phases

6 phases: Wks 1-2 (TTWB with crutches, brace locked, flexion +10 deg/day, NMES with quad sets, SLR in locked brace), Wks 2-4 (WBAT and D/C crutches during wk 2, flexion 90 deg by wk 2 and 130 deg by wk 4, stationary bike for ROM, multi-angle isometrics, open chain extension 90-45 deg), Wks 4-12 (D/C brace at 6 wks by criteria, full ROM, non-impact cardio, open chain extension through full range with resistance at 8 wks, closed chain beyond 90 deg at 8 wks), Wks 12-16 (after 3-month assessment: walk/jog progression, double-leg plyometrics once running 1/2 mile), Months 4-6 (single-leg jumps), Months 6-9 (after 6-month assessment: sport-specific drills and agility; return to sport at 9 months with surgeon clearance)

Notes

2023 revised; pediatric-focused; NMES parameters: 20-50 sec OFF, 10 sec ON, 2 sec RAMP, 75 Hz, 400 µsec, 10-15 min total; home NMES 2-3x/day until no quad lag; surgeon clearance assessments at CHOP sports PT locations at 3, 6, 9 months; CPM if available; return to sport 9 months; 10 deg/day flexion increase Phase I

Surgeon / Author

Dr. Theodore Ganley MD; Dr. Kathleen Maguire MD; Dr. Brendan Williams MD; Dr. J. Todd Lawrence MD PhD

Published

Revised 2023