Phase I: 0-4/6 Weeks (Time frame dictated by size, location of lesion)
Precautions: Brace locked 0; No OKC quad through arc of motion
Weight
Bearing / Brace / ROM / Therapeutic Exercises
•WBAT w/brace locked at 0°
•Crutch use per comfort/symptoms / • Locked 0°KF
• On when up & with leg lifting
• Optional for sleep
• Open when seated for ROM / • Emphasize full
Extension
• Progress Flex
multiple x/day
(NO forceful flexion) / • CPM x 8 hrs/day minimum
• Quad Sets in full knee extension
*NMES as needed
• SLR x 3 (Flex, Abd, Ext): Locked brace  No brace per quad control
• Beginner mat exercises for core and proximal hip strength (Isometrics)
Goals:Full hyperextension; Good quad set/activation; Resolving effusion
Phase II: 4/6-12 Weeks
Precautions: Observe & correct for knee/hip alignment (functional valgus at knee and pelvic drop) w/squatting & single limb stance activities; Observe for return of effusion & regress activities accordingly
Weight
Bearing / Brace / ROM / Therapeutic Exercises
FWB Per quad and pain control
*Limit reciprocal stair activity / • Gradually open brace per quad control with gait, CKC activities / • Full Ext
• Progress Flex to full ROM
• Stationary bike for ROM / • Initiate Basic Core Stability Poses
• Progress OKC mat exercises: reps, resistance
• Initiate basic CKC drills: 2 leg support
(Manipulate squat depth per location of lesion)
• Initiate basic L/E proprioception/balance drills: 2 legs
• Flutter kick swimming o.k. (NO kick turns)
Goals: Effusion resolved; Full ROM; Normalizing gait pattern in FWB;Multi-planar L/E strength = Grade 5/5
Phase III: 12+ Weeks*
Precautions:Continue to observe/instruct proper L/E alignment w/CKC drills (avoid functional valgus); Avoid pivoting on a planted foot, excessive impact or resistance activities through arc of motion (until 4 mos. post-op)
Weight
Bearing / Brace / ROM / Therapeutic Exercises
FWB / Protective use when out of home: environmental hazards, crowds / Full ROM / • Progress core poses BasicIntermediate
• Initiate basic cardio with bike, elliptical, walking
(15-20 minutes, minimal intensity, steady pace)
• Progress CKC drills to 1 leg per control/symptoms
• Progress L/E proprio/balance drills to single limb
Goals:Able to perform 2 leg squat ≥ 60° x 10 reps w/kinematic & symptom control; Restore normal mechanics with single leg CKC L/E activities; Able to maintain single leg balance ≥ 60 sec.; Restore normal stair climbing; Cuing for “shock absorption” with progression into higher level CKC activities and early impact activities

Jill Monson, PT, CSCSDr. Elizabeth Arendt

MPFL Reconstruction (1)

*Progression with therapy and physical activities beyond this point should be dictated by patient strength, coordination, symptom control (pain & effusion), and prior level of function.

Jill Monson, PT, CSCSDr. Elizabeth Arendt

MPFL Reconstruction (1)