MPFL Reconstruction — Medial Patellofemoral Ligament Reconstruction

Ohio State University Wexner Medical Center · OSU Sports Medicine

Weight-Bearing

WBAT with axillary crutches (refer to surgeon operative report for WB precautions); progress WBAT to FWB wks 2-4; discharge crutches once full active extension, 2x10 SLR without lag, effusion <=1+ and normal gait

Key Restrictions

Refer to operative report for WB precautions; patellar mobilizations superior/medial only for 6 wks, no lateral patellar glides; avoid isolated strengthening of graft musculature (e.g., hamstring) until 8 wks; no forced flexion beyond 90 deg with concomitant meniscal repair; refer to surgeon if full extension not achieved by 4 wks, mechanical block or clunk, or any instability episode; BFR never during plyometrics

Timeline & Phases

6 phases: Phase IA Protection (0-2 wks, ROM as tolerated, quad sets, SLR, NMES at 60-90 deg, BFR once sutures removed), Phase IB Protection (2-4 wks, WBAT to FWB, bike full revolutions, step-ups, leg press 90-0 deg), Phase IIA Moderate Protection (4-6 wks), Phase IIB Moderate Protection (6-10 wks), Phase III Return to Function (10-12 wks, isometric testing at 10 wks, begin plyometric and jogging progression once criteria met), Phase IV Return to Sport/Activity (12+ wks, isokinetic testing at 12 wks, hop testing once LSI >=80%); return to sport expectation 4.5-9 months

Notes

.edu site; CPG format, updated April 2023 (Karen Thatcher, PT, DPT); adolescent athletes may require prolonged rehabilitation (>8 months) before safe return to sport, so timeline plus criteria is recommended; graft options noted: hamstring, adductor magnus, VMO, quad tendon, allograft; outcome tools: KOOS or IKDC at initial evaluation, every 6 wks and discharge; running criteria: isokinetic quad/HS >=80% at 60 and 300 deg/sec; return to sport: isokinetic >=90%, hop LSI >=90%, physician clearance

Surgeon / Author

OSU Sports Medicine

Published

April 2023