Knee Rehabilitation Patella Stabilization

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Medial Patellofemoral Ligament Reconstruction Rehabilitation Protocol

*It is important to understand that all time frames are approximate and that progressions should be based on individual monitoring as well as type of surgery.

MPFL Reconstruction is an operation to correct for lateral patellar instability. These patients are often chronic/recurrent lateral patellar dislocators. Often times traumatic injuries lead to tears or a vulsion injuries of the MPFL.
Rehab Considerations: Patients will utilze a brace that will be locked at 0 deg during all weight-bearing activities for the first 2-4 weeks depending on quadriceps strength. ROM will be progressed as follows:

Week 0-1: 0⁰
Weeks 1-3: 0⁰→90⁰
Weeks 3-4: 0⁰→100⁰
Weeks 4-5: 0⁰→110⁰
Weeks 5-6: 0⁰→120⁰
Weeks 6-8: Full pain-free ROM

Phase I (0-4 weeks)

• Weight Bearing: Brace locked when ambulating. Unlock brace for weight bearing depending on quad control (2-4weeks)
• Recommended Treatment:
• Active warm-up: Nu-step, ¼-⅟₂revolutions on bicycle (per ROM precautions)
• Flexibility: hamstrings, gastroc-soleus complex, hipflexor.
• Strength: quad sets, SLR 4-ways, TKE against T-band, NMES for quad/vmo reeducation
• Gait training with cups (wks 2-4) to facilitate improved knee flexion in swing-phase.
• Balance/Proprioception exercises per weight-bearing status.
• Pain control: IFC and cryo-therapy. Instruct patient to ice 4-5 times per day.

Phase II (4-6 weeks)

• Weight Bearing: 100% weight-bearing without crutches (depending on quad control).
  : D/C Brace (week 6)
• Recommended Treatment:
• Active warm-up: Bike,elliptical
• Manual therapy: scar mobilization, patellar mobilizations (avoid lateral-glides)
• Flexibility: Hamstrings, gastroc/soleus, hip flexor,ITB.
• Strength: wall slides, hamstring isotonics, heel raises, SLR 4 ways, total gym. Open kinetic chain knee extension from 0⁰→45⁰ (6 weeks). Treadmill walking program.
• Gait training: with small cones if continued lack of knee flexion in swing-phase.
• Balance/Proprioception: Double limb BOSU, single leg stance on solid surface progressing to conforming surfaces.
• Pain control: IFC and cryo-therpay for pain control as needed.

Phase III (6-12 weeks)

• Weight Bearing: No restriction
• Recommended Treatment:
• Active warm-up: Bike, elliptical, stepper
• Flexibility exercises: hamstring, gastroc/soleus complex, hip flexor,ITB
• Strength: OKC knee extension (progress 0⁰→90⁰ at week 8), hip strengthening, heel raises, step-ups, step downs (eccentrics), lunges, squats, leg press, ambulate against resistance.
• Balance/Proprioception: Continue with progressions double limb→single limb, solid surface→conforming surfaces, eyes open→eyes closed, predictable→unpredictable (perturbations).
• Initiate Treadmill jogging program. (week 12-16)

Running progression

• Treadmill walking
• Treadmill walk/run interval
• Treadmill run
• Track: run straits, walk-turns
• Track: run straits and turns
• Run on road

*Progress to the next level when patient is able to perform activity for 2 miles without increased pain or effusion. Perform no more frequently than every other day. Do not progress more than 2 levels in a day period.

Phase IV (months 4-6)

• Agility drills/plyometrics
• Transition to home gym-program
• Progress running program in regards to distance and speed.
• Anticipate return to sport at 5-6 months.