MPFL Reconstruction PT Protocol

Medial patellofemoral ligament reconstruction — therapist reference

Physical Therapy Protocols · From Dr. Allred · Transcribed from the printed sheet · 7 sections

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If you have questions about a protocol or a specific patient, call the clinic where the surgery was performed.

After hours & emergency numbers → Weekdays, business hours.

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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.
Questions about this sheet? Call the clinic where the surgery was performed. I'm happy to talk through the plan. Numbers are at the top of this page, and every after-hours line is on the emergency numbers page.