Phase 1 · Weeks 0–2 (Protect & Activate)
- Goals: control pain and swelling; early ROM with a focus on full extension; quad control; wean crutches; full weight bearing as tolerated.
- ROM: flexion 0–90° by end of week 1, aim 0–120° by week 2. Full extension (heel props/prone hang); wall and heel slides.
- Quad sets; ankle pumps → 4-way Theraband; controlled weight shifts; SLR 4-way without lag; hamstring curls; mini-squats.
- Gait training PWB → FWB (requires good quad control); NMES; patellar mobilizations (all directions); soft-tissue work (quad, hamstring, ITB); cryotherapy.
Phase 2 · Weeks 2–5 (Full Motion & Gait)
- Goals: minimize effusion; maintain full extension and achieve full flexion (125–135°); normal gait, full weight bearing.
- Gait drills; stationary bike (needs ≥110° flexion); progress SLR and hamstring curls with weight; heel raises; wall/mini-squats; step-ups/downs; TKE (0–30°); hip and core.
- Proprioception: balance board, double- → single-leg (varied surfaces, eyes closed).
- Cardio: UBE; elliptical/StairMaster at week 5 as tolerated.
Phase 3 · Weeks 6–8 (Strength)
- Progress closed-chain glute/quad (split squats, leg press); lunges straight-plane → multidirectional; multidirectional hip strengthening.
- Treadmill forward/retro walk; hip and core; progress single-leg balance; stationary bike with resistance.
Phase 4 · Weeks 9–12 (Power Prep)
- Single-leg squats; mini-trampoline (hopping, jogging); line jumping (double- → single-leg); walking lunges with rotation.
- Hip and core; aqua jogging; bike/elliptical/StairMaster with resistance.
Phase 5 · Weeks 13–15 (Running & Agility)
- Begin straight-line running when criteria are met: no effusion, good single-leg control, quad strength ≥80% of the other leg, and ~30 single-leg squats without difficulty.
- Progress agility low- to high-velocity: skipping, side shuffle, quick steps, carioca, crossovers, high knees, shuttle and ladder drills, cutting/pivoting/figure-eights, and landing mechanics (double- → single-leg).
- Add work- or sport-specific proprioception drills.
Return to Sport (Criterion-Based)
- Apprehension-free exam with good patellar tracking; full symmetric ROM and no effusion.
- Quadriceps and hop-test symmetry ≥90% (≥80% before beginning impact).
- Clean cutting and landing mechanics with good valgus control.
- Gradual sport-specific progression to full participation — typically ~6–9 months and testing-driven, not calendar-based.
References
- Current Concept Review: MPFL Reconstruction — From Rehabilitation to Return to Sport. Int J Sports Phys Ther.
- Rehabilitation and Return to Sport After Medial Patellofemoral Complex Reconstruction. PMC.