Patellar Realignment — MPFL Reconstruction and Tibial Tubercle Osteotomy

UCLA Department of Orthopaedic Surgery - Sports Medicine · Thomas Kremen MD

Weight-Bearing

NWB x 4 wks; 50% WB wks 4-6; FWB at 6 wks; brace locked in extension x 8 wks for ambulation; crutches x 8 wks

Key Restrictions

NWB x 4 wks; 50% WB wks 4-6; FWB at 6 wks; brace locked in extension for all activities wks 0-4 (sleep included); unlock brace for sleep at wks 4-6; brace locked in extension for ambulation wks 4-8; D/C brace with physician guidance; no CKC x 4 wks; CPM 8 hrs/day: wk 1 0-45°, wk 2 0-60°, wk 3 0-75°, wk 4 0-90°; extreme attention to patellar mobs 4 directions (especially inferior and superior); short arc quads 0-20° and 60-90° in Phase II; leg press 0-45° Phase III; driving at 4 wks; D/C crutches at 8 wks when criteria met

Timeline & Phases

Phase I (0-6 wks): NWB x 4 wks then 50% WB, brace locked in extension (sleep unlocked at wk 4), CPM 8 hrs/day 0-45° → 0-90° wks 1-4, patellar mobs 4 directions (especially inferior/superior), quad sets/SLR, heel slides 0-90°, NWB gastroc/soleus/HS stretches, resisted ankle ROM | Phase II (6-8 wks): WBAT with 2 crutches, brace unlocked for sleep (locked for ambulation wks 6-8), balance/KAT, aquatic therapy, short arc quads 0-20° and 60-90°, wall slides 0-45° → mini-squats, stationary bike low resistance high seat | Phase III (8 wks - 4 months): D/C crutches when criteria met (no lag, full extension, non-antalgic gait), step-ups 2→8", stationary bike progressing resistance, 4-way hip, leg press 0-45°, CKC TKE, swimming/Stairmaster, toe raises, HS curls, treadmill, proprioception, gastroc/soleus/HS/ITB/quad flexibility | Phase IV (4-6 months): CKC progression, pool jogging with wet vest, functional/sport-specific activities or work hardening

Notes

Same protocol for proximal and distal realignment (MPFL reconstruction and tibial tubercle osteotomy) except ROM limitations as noted; extreme attention to patellar mobs in 4 directions especially inferior and superior — also massage infrapatellar fat pad; CPM 8 hrs/day wks 1-4 with progressive ROM; driving at 4 wks; short arc quads 0-20° and 60-90° (protects PF joint) in Phase II; D/C CPM when ≥90° flex achieved; criteria to D/C crutches at 8 wks: no SLR lag, full extension, non-antalgic gait; PT 2/wk Phases I-II, 1-2/wk Phase III, 1/wk → every 2 wks Phase IV; Kremen MD UCLA PatientPop practice site

Surgeon / Author

Thomas Kremen MD