MPFL Reconstruction

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

Brace locked in extension for ambulation/sleeping x2 wks Phase I (may unlock while sitting); progressive ROM unlocking through Phase I; brace unlocked with safe gait required to progress to Phase II

Key Restrictions

Avoid active extension Phase I; avoid post-activity swelling and closed chain exercises on land past 90 deg Phase II; no running until Phase III; heat before exercise/ice after Phase III

Timeline & Phases

Phase I (surgery-6 wks): protect post-surgical limb, reduce swelling, control pain, restore leg control and normalize gait, brace locked in extension for ambulation/sleeping x2 wks (may unlock while sitting), avoid active extension, ROM progression (0-30 deg x2 wks, then 0-60 deg x2 wks, then unlimited while maintaining full extension), quad sets, SLRs with brace on, ankle isotonics with bands, begin pool walking at 4 wks, UBE/upper body circuit; progress to Phase II after 6 wks if safe gait with brace unlocked, no effusion, 0-90 deg ROM; Phase II (6-12 wks): progressive squat program, initiate step-down program, leg press, lunges, single leg standing control, no effusion, short arc quad control pain-free with steps/partial squats, good quad control, full ROM, improve hip/core strength/balance/proprioception, avoid post-activity swelling and closed chain exercises on land past 90 deg, no running, continue pool work, gait drills, functional single-plane closed chain movements, agility exercises (sport cord), balance/proprioceptive exercise, single leg balance board, swimming with flutter kick (no breaststroke), Stairmaster, water walking, stationary bike, Versaclimber/NordicTrack; progress to Phase III after 2 wks if goals met, normal gait on level surfaces, good leg control without extensor lag/pain/apprehension, single leg balance at 30 deg flexion >20 sec; Phase III (12+ wks): good eccentric/concentric neuromuscular control, multiplane limb control, return to work/sports including impact, heat before exercise/ice after, post-activity soreness resolves within 24 hrs, begin forward treadmill running when 8in step-down satisfactory, impact control exercises (2 feet-2 feet, then 1 foot to other, then 1 foot to same), movement control low-to-high velocity/single-to-multi-planar, sport-specific balance/proprioceptive drills, plyometric program, hip/core strengthening; return to sport MD-directed generally >22 wks

Notes

OSMS Rehabilitation Guidelines; patellar realignment procedure; surgical approach varies by surgeon/location but therapy principles are generally accepted