MPFL Reconstruction

Dr. David P. Trofa MD (Columbia University Medical Center) · Dr. David P. Trofa MD (Head Team Physician, Columbia University)

Weight-Bearing

WBAT with hinged brace locked in extension wks 0-6; WB as tolerated with focus on normal gait wks 6-12; full WB from 3 months

Key Restrictions

Hinged brace locked in extension for all activities including sleep wks 0-6 (removed for PT, ROM and hygiene); discontinue brace after a strong set of 30 SLRs; ROM 0-60 deg wks 0-2, 0-90 deg by 1 month and 120 deg by 6 wks, full 0-130 deg wks 6-12; no active knee extension until 6 wks; avoid patellar lateralization; medial-only gentle patellar mobs; closed chain strengthening only at >=60 deg knee flexion wks 6-9, then advance about 20 deg/wk to full range by 3 months; no lunges; first season back in a J-brace

Timeline & Phases

4 phases: Phase I (0-2 wks, protection, ROM to 60 deg, quad sets, hamstring sets, core/hip), Phase II (2-6 wks, healing, ROM to 90 deg by 1 month and 120 deg by 6 wks, SLR in locked brace, goal 30 SLRs to graduate from brace), Phase III (6-12 wks, transitional, normalize gait, closed chain strengthening by knee-angle rule, bike at 6 wks, rowing/elliptical/Stair Master at 8 wks, swimming at 10 wks), Phase IV (3-6 months, light plyometrics at 3 months advancing at 4, running program once criteria met, sport-specific work 4.5-6 months, high-impact and contact sports at about 5-6 months)

Notes

Columbia University Medical Center; brace discontinued by SLR criterion (30 SLRs), not by date; running criteria: normal gait for 20 min, ROM >0-125 deg, quad and hamstring strength >70% of contralateral, no pain, effusion, crepitus or giving way; return to sport requires >90% limb symmetry on strength and functional testing; first season back in a J-brace

Surgeon / Author

Dr. David P. Trofa MD (Head Team Physician, Columbia University)