MPFL / MQFL Reconstruction

Phase I – Maximum Protection (Weeks 0 to 6):

0 to 2 weeks:

• Brace locked in full extension for 6 weeks during ambulation
• Partial weight bearing for 2-3 weeks
• Ice and modalities to reduce pain and inflammation
• patella and patella tendon mobility drills Gentle superior/ inferior only
• **No lateral patellar glides**
• Gentle patella tendon med/lat mobs
• Quad sets in brace
• Start Range of motion – 0° to 30°, progressing slowly
• ROM:
• 0-30° (week 0-3)
• 0-45° (week 4)
• 0-60° (week 5)
• 0-90° (week 6)
• Begin quadriceps setting- when pt can perform strong QS, start with SLR without a quad lag; begin hip abduction and hip extension when pt masters SLR w/out lag.

Weeks 3 to 4:

• Weight bearing as tolerated; progressing off of crutches; knee brace locked in ext
• Continue with inflammation control
• Continue with patella mobility as above
• Continue with submaximal quadriceps setting

Weeks 4 to 5:

• Full weight bearing
• Continue with ice and patella mobility all planes
• Range of motion – 0° to 70°
• Increase intensity with quadriceps setting

Weeks 5 to 6:

• Continue with Patella Mobility
• Range of motion 0° to 90°
• Open brace to 45°- 60° of flexion for NWB activities

Phase II – Progressive Range of Motion and Early Strengthening (Weeks 6 to 12):

Weeks 6 to 8:

• Full weight bearing
• Open brace to 0°-90° of flexion week 6 for ambulation
• Continue with swelling control and patella mobility
• Gradually progress to 125° range of motion
• Begin multi-plane straight leg raising and closed kinetic chain strengthening program focusing on quality VMO function.
• Initiate open kinetic chain progressing to closed kinetic chain multi-plane hip strengthening
• Normalize gait pattern
• Begin stationary bike week 8
• Initiate pool program

Weeks 8 to 10:

• Wean out of brace (week 9+)
• Continue with patellar mobility drills (**no lateral glides**)
• Normalize gait pattern
• Restore full ROM
• Progress open and closed kinetic chain program from bilateral to unilateral
• Increase intensity on stationary bike
• Begin treadmill walking program forward and backward
• Begin elliptical trainer

Weeks 10 to 12:

• Full ROM
• Begin quadriceps stretching
• Advance unilateral open and closed kinetic chain strengthening

Phase III – Progressive Strengthening (Weeks 12 to 16):

Weeks 12 to 16:

• Advance open and closed kinetic chain strengthening
• Increase intensity on bike, treadmill, and elliptical trainer
• Increase difficulty and intensity on proprioception drills
• Begin gym strengthening: leg press, hamstring curls, ab/adduction; avoid lunges and knee extensions
• Begin multi-directional functional cord program

Phase IV – Advanced Strengthening and Functional Drills (Weeks 16 to 20):

Weeks 16 to 20:

• May begin leg extensions; 30° to 0° as tolerated
• Begin pool running program advancing to land as tolerated

Phase V – Plyometric Drills and Return to Sport Phase (Weeks 20 to 24):

Weeks 20 to 24:

• Advance gym strengthening
• Progress running/sprinting program
• Begin multi-directional field/court drills
• Begin bilateral progressing to unilateral plyometric drills
• Follow-up appointment with physician
• Sports test for return to competition

RETURN TO ACTIVITIES

Running: 6 months when functional criteria are met

Golf: Short irons at 5 months, full swing with long irons at 6 months.

Delay 4-6 weeks if lead leg.

Pivoting/cutting sport: When functional criteria are met and cleared by surgeon, typically

7+ months at earliest