Medial Patellofemoral Ligament Reconstruction
WEEK 1-2:
Weight Bearing
- Touch Down Weight Bearing (1/6th body weight)
Brace
- Locked at 0° extension
- OK to remove for exercises, hygiene
- Wear at night while sleeping
ROM
- As tolerated
Therapeutic Exercise
- Flexion: Heel slides to patient tolerance
- Extension: Passive knee extension using towel roll, prone hangs
- Strengthening: Quad setting with knee support, Straight leg raises with brace locked in extension until quad strength prevents extension lag, hamstring digs with knee support, plantarflexion/ dorsiflexion, eversion/inversion strengthening
WEEK 2-6:
Weight Bearing
- Weight bearing to tolerance, wean from crutch use
Brace
- Continue to wear hinged knee brace
- Unlock brace when quad control is adequate for knee support
- May remove brace for exercise, hygiene and for sleeping if desired
ROM
- As tolerated, goal for knee flexion is 90°
Therapeutic Exercise
- No weight bearing exercise at flexion angle > 90°
- Flexion: wall slides, heel slides, sitting flexion
- Extension: Passive knee extension using towel roll, prone hangs
- Open kinetic chain: straight leg raise, Hip abd/adduction, hip extension, hamstring set or prone hamstring curl
- Closed Kinetic Chain: Heel raises, leg press with minimal resistance, weight shifting onto single leg
- Trunk stabilization
- Manual Interventions: patellar mobs, tibiofemoral mobs into extension, soft tissue as indicated
WEEK 6-12:
Weight Bearing
- Full weight bearing without crutches
Brace
- Patellar stabilization brace when ambulating
ROM
- Continue to advance to full painless ROM
Therapeutic Exercise
- Stationary Bike
- Closed Kinetic Chain: step downs, single leg balance, terminal active knee extension to 0° against resistance, full squat to 90°, single leg squat, elliptical, treadmill walking if gait pattern is functional
- Wall Sits
- Lunges
MONTH 3-4:
Weight Bearing
- Full weight bearing without crutches
Brace
- Patellar stabilization brace for sport activities only
ROM
- Full
Therapeutic Exercise
- Advance strengthening
- Proprioception / Plyometrics
- Treadmill jogging / elliptical
- Agility drills, sport specific drills
MONTH 4-6:
Weight Bearing
- Full weight bearing
Brace
- None
ROM
- Full
Therapeutic Exercise
- Gradual return to sport
- Home Maintenance Program
