MPFL Reconstruction — Pediatric

Massachusetts General Hospital · MGH Brigham Pediatric Sports Medicine

Weight-Bearing

PWB 25% with brace locked in extension wks 0-2; WBAT Phase II; FWB Phase III

Key Restrictions

Brace locked, PWB 25% wks 0-2; unlock brace once SLR without lag; DC brace at 6 wks per surgeon; knee flexion limited: 30 deg wk 1/60 deg wk 2/90 deg wk 4/110 deg wk 6; concomitant tibial tuberosity osteotomy (TTO) alters WB/ROM/assistive device — confirm with surgeon; adductor strengthening emphasized throughout; no plyometrics until Phase IV

Timeline & Phases

Phase I (0-2 wks): PWB 25% brace locked, patellar PROM, NMES 2500 Hz, quad sets, SLR (no lag), hip abduction, standing hamstring curl; Phase II (3-6 wks): WBAT, stationary bike, adductor strengthening (ball squeezes, SLR adduction, bridging with ball squeeze), squats 0-60 deg, balance; Phase III (7-12 wks): FWB, elliptical/stair climber ~8 wks, single leg progression (step-ups, step-downs, SL squats, lateral lunges, RDL), perturbation training; Phase IV (13-16 wks): bilateral plyometrics, progress balance; Phase V (4-5 mo): return-to-run, agility/plyometrics; Phase VI (6+ mo): multi-plane cutting/pivoting, non-contact to full play ~6-7 mo

Notes

Revised 3/2024; 6-phase protocol; discharge Phase V: quad/HS/glut >=95%, H:Q >=66%, hop >=95%, Lysholm >90%, KOOS-sports >90%, IKDC >93, ACL-RSI; Phase VI: no additional criteria; NMES 2500 Hz 75 bursts; TTO concomitant procedure requires surgeon consultation on restrictions. [Archived copy — original Massachusetts General Hospital URL retired in the Mass General Brigham site migration; Wayback snapshot 2025-10-09.]

Surgeon / Author

MGH Brigham Pediatric Sports Medicine

Published

2024-03