Medial Patellofemoral Ligament (MPFL) Reconstruction Rehabilitation Protocol

The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an arthroscopic assisted/mini-open rotator cuff repair. It is by no means intended to be a substitute for one’s clinical decision-making regarding the progression of a patient’s postoperative course based on their physical exam/findings, individual progress, and/or the presence of postoperative complications. If a clinician requires assistance in the progression of a postoperative patient, they should consult with Dr. Roe.

Progression to the next phase based on clinical criteria and/or time frames as appropriate

Phase I – Acute (0-6 weeks): 

Goals: 

  • Protect repair, restore ambulation and ADL status.
  • Weightbearing:
    • 0-2 weeks: Partial weight-bearing.
    • 2+ weeks: WBAT.

Brace and crutches:

  • 0-1 week: Brace locked in full extension.
  • 2-4 weeks: Open brace 60 degrees if good quad control.
  • 4-6+ weeks: Open to full and discontinue when gait is normal.

Strengthening and conditioning:

  • Quad sets, straight leg raises, single-leg balance, upper body ergometer, hip abduction strengthening.

Criteria for Phase Progression: 

  • Pain < 3/10 at worst.
  • Within two degrees normal knee extension and 90 degrees knee flexion.
  • Adequate single leg balance > 20s (firm ground).
  • MD or PT approval.

Phase II – Strength (7-12 weeks): 

Goal: Improved strength and initiate jogging program.

Range of motion:

  • 6+ weeks - gradually progress flexion to full over the next four weeks.

Strengthening:

  • Short arc leg press, step-ups, Romanian deadlifts (RDLs).
  • Squat progression (bodyweight squats 🡪 single-leg squats).
  • Resisted hip abduction, lateral band walks, core exercises (V-ups, single-leg bridging).

Conditioning:

  • Stationary biking – initiated at 115 degrees of flexion.
  • Elliptical and rowing machine after 10 weeks.

Criteria for jogging: 

  • At least 12 weeks post-op.
  • Pain < 3/10 at worst.
  • Within two degrees normal knee extension and 20 degrees knee flexion.
  • At least one minute of single-leg squats.
  • MD or PT approval.

Phase III – Agility (12-16 weeks): 

Goal: Introduced dynamic and power movements.

Strengthening:

  • Gym-specific strengthening (barbell squats and deadlifts).
  • Biodex quad and hamstring fatiguing protocols.
  • Core exercises (mountain climbers, V-ups).

Conditioning:

  • Road or stationary biking.
  • Jogging program.
  • Swimming (progress kicking gradually and pain-free).

Plyometrics and light agility:

  • Ladder drills, box jumps (up to 12”), side shuffle.

Criteria for heavy agility and sport-specific movements:

  • 16 weeks post-op.
  • Pain < 2 at worst.
  • Quad and HS strength > 80% normal; >50% H/Q ratio for females.
  • At least two minutes of single-leg squats (resisted).
  • <5 on landing error scoring system (LESS).
  • MD or PT approval.

Phase IV – Return to play (16-20+ weeks): 

Goal: Initiate sport-specific movements and return to play.

Strengthening:

  • Progress gym routine (squats, deadlifts, with peak lifting).
  • Biodex quad and hamstring fatiguing protocols and core exercises.

Conditioning:

  • Jogging, biking, swimming.
  • Interval sprint workouts.

Plyometrics and agility:

  • Max effort box jumps (progression with rotation.
  • Lateral and rotational agility.
  • Single leg hops.
  • Unpredictable cutting and contact drills.

Criteria for return to play:

  • Pain < 2 at worst.
  • Quad and HS strength > 90% normal; >60% H/Q ratio for females.
  • At least 3 minutes of single-leg squats (resisted).
  • 90% normal in all single-leg hop test.
  • 95% normal figure-of-eight, 5-10-5 agility, single-leg vertical jump.
  • MD or PT approval.