PT Protocols

MPFL Reconstruction

General Goals

  1. Restore normal joint function
    1. Control pain and inflammation
    2. Restore range of motion
    3. Restore muscle strength
    4. Improve proprioception and agility
    5. Restore endurance
  2. Return to pre-injury unrestricted and sporting activity
    1. 90% muscle strength and endurance as determined by isokinetic testing or functional hop test
    2. Functional hop test
      1. 3 consecutive SLH for distance (90% of contralateral normal)

Post-Op Phases

Phase I: 0-4 weeks

  1. Brace:
    1. Protected weight bearing. NWB in brace
    2. SLR with no extension lag
    3. Good quad control
  2. Exercises
    1. Quad sets (SLR’s) hourly  +/- e-stim (4 directions)
    2. Ankle pumps, HS and gluteal sets
    3. Active extension from 90-50 degrees out of brace
    4. * Patella Mobs – superior/inferior and med/lat
    5. AROM/PROM exercises – (0-90 degrees)
    6. Hip flexor exercises, hip abductor exercises

Phase II: 5-8 weeks

  1. Criteria to progress to phase II
    1. Minimal swelling
    2. Gait with full extension
    3. Ability to lock knee while weight bearing
  2. Can discontinue brace beginning week 5
  3. Advance to FWB/no crutches over this phase
  4. Exercises
    1. Increase AROM/ PROM beyond 90 degrees: no limits
    2. Stationary bike: no resistance
      1. Advance duration as tolerated
    3. Resisted gastroc/soleus exercises with theraband only
    4. Progress to bilateral toe raises and then to unilateral toe raises
    5. Resisted hamstring curls with therabands
    6. Step-ups (lateral and forward) on 2-4 inch steps
      1. Increase at own individuals pace
    7. Forward and backward walking with theraband around thighs
    8. Ankle weights to SLR if no extension lag.

Phase III: 9-12 weeks

  1. Criteria to progress to phase III
    1. Full active extension and 110 degrees of flexion
    2. No extension lag
    3. Good quad control on single leg stance
    4. Stairs foot over foot
    5. WBAT
  2. Program
    1. Stationary cycle with light resistance
      1. RPM>80
      2. Progress to 15-20 minutes per day
    2. Leg Press or Total Gym 40-45 degrees knee flexion toward full extension
    3. Calf raises using leg machine to add resistance
    4. Proprioception exercises
      1. Balance Board/BABS
      2. Theraband “kicks” (wt bear on operative leg)
      3. Pool program if available
      4. Resistance Walking (forward/backward)
      5. Hip exercises (all muscle groups)
    5. Stairstepper or seated Kinitron if no anterior knee pain
      1. Begin for 1-5 minutes
      2. Short steps (4-6”) Can gradually increase time to 15 minutes

Phase IV: 12 weeks +

  1. Criteria to progress to phase IV
    1. Full AROM
    2. Normal gait
    3. No swelling or pain
  2. Program
    1. Increase intensity and resistance for exercises above
    2. Heel taps
    3. Start light agility drills
      1. Carioca
      2. Single-leg hopping on total gym
    4. Slow lunges with tubing
  3. Exercises at 16 weeks
    1. Perform isokinetic testing (180deg/sec) or single leg hop 3 consecutive for distance
    2. Begin light jogging on treadmill
    3. Lunges and side-to-side and front-back agility work
      1. Side-to-side jumps and hops
      2. Side-to-side steps
    4. Single leg hopping off total gym
    5. Braiding
    6. Jumping rope
    7. Weight machines
      1. Increase weight and intensity for all lower extremity muscle groups
      2. 10% increases weekly
      3. Open and closed chain exercises
      4. Plyometrics
    8. HEP