Mr Gilbert and Mr Coupe
Sports Knee Clinic
Wrightington Hospital
POST-OPERATIVE MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION PROTOCOL
Ensure patient achieves milestone prior to progression
Timings are a guideline only and progression should be individual to the patient
No return to contact sports prior to 3 months post-op return to sport dictated by particular sport, ability, fitness, confidence, and completion of
Phase 4 of the protocol
Any problems during rehabilitation please contact Jo Armstrong, Wrightington Physiotherapy Department, 01257 256533
PHASE 1 EARLY POST-OPERATIVE PHASE (day 1 - 2 weeks)
Goal
Treatment
Milestone to Progress to Phase 2
Minimise swelling and pain
Use of ice
Ensure adequate pain relief
Elevate leg
Use of crutches
Cricket pad splint for mobilizing for 48 hours
Minimal or no effusion
Pain levels managed to enable exercise
Extension exercises: static quads, heel props,
Ability to activate quads
Symmetrical gait pattern with crutches
Regain full range of extension/hyperextension
prone hanging
Passive stretching
Increase knee flexion as pain allows
Passive, active assisted and active flexion
exercises
Activate quadriceps
Early hip/gluteal strengthening
Hip abduction/extension/ER strengthening
Restoration of normal gait pattern
Gait re-ed with elbow crutches, WB as pain and
Static quads hourly
Use of EMS if available
VMO
SLR if possible
control allows
1
progression
Full or nearing full extension
Knee flexion 70- 90
PHASE 2 - QUADS ACTIVATION AND CORE STRENGTH (approximately 2 weeks - 6 weeks)
Goal
Treatment
Milestone to Progress to Phase 3
Minimise swelling and pain
Continue as above
Regain full range of extension/hyperextension
Extension exercises as above
Passive stretching
Increase knee flexion as pain allows
Active flexion exercises
Progress to quads stretch
Improve quads strength
Static quads
SLRs - ensure no lag
VMO
Improve gluteal strength and general lower limb
strength
Restoration of normal gait pattern
Ensure FWB without crutches once adequate
quads control
Commence proprioceptive work/balance work
Weight transfer
Progress to single leg stands once adequate
quads control
Wobble board/sit fit
Improve core strength
Core stability strengthening
Continue hip abduction/extension/ER/bridging
Hamstring curls and calf raises
Exs bike
Begin mini squats once adequate strength and
control
Minimal/no effusion
Full range extension
Full or nearing full range flexion
SLR with no lag
Bilateral squat to 60 with even, symmetrical WB
FWB
Single leg stand for at least 5 seconds
PHASE 3 - STRENGTH AND CONTROL (approximately 6 weeks - 12 weeks)
Goal
Treatment
Milestone to Progress to Phase 4
Minimise swelling and pain
Continue cryotherapy and elevation as necessary
Regain/maintain full range of flexion and extension
Continue stretching regime
Improve quads, hamstrings, gluteal and general
lower limb strength
Squats to 90, lunges, leg press, VMO
Hamstring curls
Continue hip abduction/extension/ER with
increased resistance
Exs bike, step ups, cross trainer
Improve neuromuscular control
Knee alignment/prevent valgus - single leg squats,
lunges (+/- trunk rotation), step ups/downs (ensure
good hip/knee/ankle alignment)
Restoration of normal gait pattern
Treadmill walking - forwards/backwards/incline
Progress to straight line jogging only when good
load acceptance and neuromuscular control
Improve proprioception
Single leg stands eyes shut
Wobble board/sitfit/BOSU/trampette
Improve core strength
Progress core stability strengthening
Commence bilateral load acceptance/early
plyometrics if returning to sport
Bilateral drop jumps
Jumps with symmetrical squat landing
Minimal/no activity related effusion
Full ROM
No instability/patellar apprehension
Normal, symmetrical gait/jogging pattern
10 x single leg squats to 60 with good alignment
and control (i.e. no valgus & good hip/knee/ankle
alignment)
Single leg stand with eyes shut over 80% of
unaffected leg
PHASE 4 - RETURN TO SPORTS PREPARATION (from 12 weeks approximately)
Goal
Treatment
Milestone to Progress to Return to Sport
Minimise activity related swelling and pain
Continue cryotherapy and elevation as necessary
post exercising
Dynamic neuromuscular control with multi-plane
activities without instability or pain
Increase lower limb muscle strength and endurance
Continue strengthening all muscle groups using
increased loads for resistance
Continue core stability strengthening
Improve neuromuscular control following fatigue
Ensure ability to control alignment after fatigue and
during sports specific drills
Normal straight line running pattern in full control
Improve proprioception
Progress to dynamic proprioception exercises
Progress bilateral load acceptance to unilateral load
acceptance/plyometrics and work to fatigue
Commence sports specific running agility drills
Sprinting
Cutting and pivoting
Progress jogging to running
Increase speed/distance
Change surface/incline
Forward running/backward running
Tuck jumps
Squat jumps - forward/back/rotational
Bilateral plyometric static and multi-plane exs
Single leg hop
Forward, side hops/drop from step with controlled
single leg landing
Unilateral plyometric static and multi-plane
activities
Increasing speed and intensity to fatigue
Acceleration and deceleration
Commence sports specific skills
One on one practice drills, ball skills, kicking,
boxing, racquet sports
REFERENCES
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The American Journal of Sports Medicine, 37(10), 2021-2027
Andrish, J (2008) The Management of Recurrent Patellar Dislocation. Orthop Clin N Am, 39, 313-327
Buckens, C, Saris, D (2010) Reconstruction of the Medial Patellofemoral Ligament for Treatment of Patellofemoral Instability: A Systematic Review. American
Journal of Sports Medicine, 38, 181-188
Chichanowski, H, Schmitt, J, Johnson, R, Niemuth, P (2007) Hip Strength in Collegiate Female Athletes with Patellofemoral Pain. Medicine & Science in Sports &
Exercise
Ellera Gomes, J, Marczyk, L, Cesar de Cesar, P, Jungblut, F (2004) Medial Patellofemoral Ligament Reconstruction with Semitendinosus Autograft for Chronic
Patellar Instability: A Follow-up Study. Arthroscopy: The Journal of Arthroscopic and Related Surgery, 20 (2) 147-151
Fisher, B, Nyland, J, Brand, E, Curtin, B (2010) Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation: A Systematic Review Including
Rehabilitation and Return-to-Sports Efficacy. The Journal of Arthroscopic and Related Surgery, 26 (10), 1384-1394
Fithian, D Powers, C, Khan, N (2010) Rehabilitation of the Knee after Medial Patellofemoral Ligament Reconstruction. Clin Sports Med, 29, 283-290
Hinton, R, Sharma, K (2003) Acute and Recurrent Patellar Instability in the Young Athlete. Orthop Clin N Am, 34, 385-396
Howells, N, Eldridge, J (2012) Medial Patellofemoral Ligament Reconstruction for Patellar Instability in Patients with Hypermobility. The Journal of Bone and Joint
Surgery, 94-B (12) 1655-1659
McGinty, G, Irrgang, J, Pezzullo, D (2000) Biomechanical Considerations for Rehabilitation of the Knee. Clinical Biomechanics, 15, 160-166
Matthews, J, Schranz, P (2010) Reconstruction of the Medial Patellofemoral Ligament using a Longitudinal Patellar Tunnel Technique. International Orthopaedics
(SICOT), 34 1321-1325
Minkowiitz, R, Inzerillo, C, Sherman, O (2007) Patella Instability. Bulletin of the NYU Hospital for Joint Diseases, 65 (4), 280-293
Ronga, M, Oliva, F, Longo, UG, Testa, V, Capasso, G, Maffulli, N (2009) Isolated Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation.
American Journal of Sports Medicine, 37, 1735-1742
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Reconstruction for Patellar Instability. Critical Reviews in Physical and Rehabilitation Medicine, 19 (2), 79-95
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