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

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