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Aaron WeyMD, FAAOS, FACSAdult and Pediatric Spine Surgery
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Knee · Post-op rehabilitation protocol

Medial Patellofemoral Ligament Repair or Reconstruction

After medial patellofemoral ligament repair or reconstruction: brace opened in stages over nine weeks, weight bearing as tolerated, full activity at six months

This is the rehabilitation plan I ask your physical therapist to follow after this operation. Bring it to your first therapy visit. It is a framework, not a prescription: your therapist adjusts the pace to how you are healing, and anything we discussed in the office takes precedence over what is printed here. If something on this page does not match what we talked about, ask me.

Physical therapist: please send progress notes to the office at (201) 836-1663 and call with any question about the plan.

Days 1–14

Exercises

  • Dressing – POD 1: Debulk dressing, TED Hose in place
    • POD 2: Change dressing, keep wound covered, continue TED Hose
    • POD 7–10: Sutures out, D/C TED Hose when effusion resolved
  • Brace – Days 1–7: Locked in extension
    • Weeks 1–2: Locked at 0–20 degrees
  • Crutches – Weight bearing as tolerated (WBAT) (D/C when gait is normal)
  • AROM, AAROM 0–20 degrees
  • Patellar mobilization (teach patient)
  • Calf pumping
  • Passive extension with heel on bolster or prone hangs
  • Electrical stimulation in full extension with quad sets and SLR
  • Quad sets, Co-contractions quads / HS
  • Straight leg raise (SLR) x 4 on mat, in brace (parallel bars if poor quad control)
  • Double leg heel raises
  • Gentle Hamstring stretching
  • Ice pack with knee in full extension after exercise

Goals

  • Pain / effusion control
  • No extensor lag

Weeks 2–4

Exercises

  • Brace – Weeks 2–3: 0–45 degrees
    • Weeks 3–4: 0–60 degrees
  • Continue appropriate previous exercises
  • Scar massage when incision healed
  • AAROM, AROM 0–60 degrees
  • SLR x 4 on mat, without brace – no resistance
  • Single leg heel raises
  • Stretches – Hamstring, hip flexors, ITB

Goals

  • Normal gait
  • AROM 0–60 degrees

Weeks 4–6

Exercises

  • Brace – Weeks 4–5: 0–75 degrees
    • Weeks 5–6: 0–90 degrees
  • Continue appropriate previous exercises
  • AROM, AAROM 0–90 degrees
  • Standing SLR x 4 with light weight at ankle
  • Weight shifts, Mini squats
  • Short arc quads with light weight as tolerated
  • Total Gym – Mini squats (level 3–5) – No flexion > 45 degrees
    • Passive flexion to 90 degrees (push up with opposite leg)
  • Leg press 0–45 degrees with light resistance
  • Hamstring curls 0–45 degrees – Carpet drags or rolling stool (closed chain)
  • Proprioception ex – Double leg BAPS
  • Stationary bike for ROM
  • Pool therapy

Goals

  • ROM 0–90 degrees
  • No effusion

Weeks 6–9

Exercises

  • Brace – Weeks 6–7: 0–105 degrees
    • Weeks 7–9: 0–120 degrees
  • Continue appropriate previous exercises
  • PROM, AAROM, AROM through full range
  • Wall squats – No knee flexion past 45 degrees
  • Standing SLR x 4 with Theraband bilaterally
  • Forward, lateral and retro step downs
    • No knee flexion past 45 degrees (small step)
  • Proprioceptive ex – Single leg BAPS, ball toss, and body blade
  • Hamstring curls through full range – Carpet drag or rolling stool (closed chain)
  • Stationary bike – Progressive resistance and time
  • Elliptical trainer
  • Treadmill – Forwards and backwards walking

Goals

  • Full AROM

Weeks 9–12

Exercises

  • D/C brace
  • Continue appropriate previous exercises with progressive resistance
  • PROM, AAROM, AROM to regain full motion
  • Hamstring curl weight machine
  • Knee extension weight machine
  • Hip weight machine x 4 bilaterally
  • Forward, lateral and retro step downs – Medium to large step
  • Treadmill – Walking progression program

Goals

  • Walk 2 miles at 15 min/mile pace

Months 3–4

Exercises

  • Continue appropriate previous exercises
  • Fitter
  • Slide board
  • Agility drills – figure 8s, gentle loops, large zigzags
  • Swimming
  • Stairmaster – Small steps
  • Treadmill – Running progression program
  • Quad stretches

Goals

  • Run 2 miles at normal pace

Months 4–6

Exercises

  • Continue appropriate previous exercises
  • Agility drills / Plyometrics
  • Sit-up progression
  • Progressive weight training program
  • Running progression to track
  • Transition to home / gym program

Goals

  • Return to all activities
  • Pass a return-to-sport / fitness test at 6 months post-op
  • No contact sports until 6 months post-op

Home exercise sheet · knee phase 1

Perform exercises below frequently: 30 reps 3–5x a day

  • Quad Isometrics
  • Heel Slides
  • Active Assisted Motion
  • Ice Position 15 minutes 2–3 x per day

Abbreviations

AROM / AAROM / PROM: active / active-assisted / passive range of motion. ROM: range of motion. ER / IR: external / internal rotation. ABD / ADD: abduction / adduction. FLEX / EXT: flexion / extension. WBAT / PWB / TTWB / NWB: weight bearing as tolerated / partial / toe-touch / non-weight bearing. SLR: straight leg raise. HS: hamstrings. ITB: iliotibial band. UE / LE: upper / lower extremity. UBE: upper body ergometer (arm bike). BAPS: balance board. BFR: blood flow restriction training. PREs: progressive resistance exercises. D/C: discontinue. prn: as needed. POD: post-operative day. TENS: transcutaneous electrical nerve stimulation. ADLs: activities of daily living.

Source

Adapted from William Beaumont Army Medical Center, Physical Therapy Section, "Med PF Lig Repair WB08", Revised August 2008, published by William Beaumont Army Medical Center (a work of the U.S. Government in the public domain). Original: Med PF Lig Repair WB08.pdf. Army-specific wording in the original (APFT) was replaced with civilian equivalents.

This protocol is general guidance for the rehabilitation team and does not replace the specific plan, restrictions and follow-up we set together. Your own situation may differ: if anything here does not match what we talked about, what we talked about wins, so please ask me.