MPFL Reconstruction

Physical Therapy Protocol

Phase I – Maximum Protection (Weeks 0–2)

Goals:

• Protect the surgical repair
• Control swelling and pain
• Begin early controlled ROM
• Prevent quadriceps atrophy

Restrictions:

• Weight Bearing: Toe-touch weight bearing (TTWB) for 6 weeks
• ROM Limit: 0°–90° PROM
• Brace: Locked in full extension (0°) at all times except during therapy

Exercises:

• Flexion/Extension – wall slides
• Flexion/Extension – seated
• Patella/Tendon mobilization (no medial/lateral glides)
• Extension mobilization
• Quad sets
• Ankle pumps
• Sit and reach for hamstrings (towel)
• Balance series (gentle)

Cardiovascular:

• Bike/Rowing with well leg only

Phase II – Controlled Motion (Weeks 3–6)

Goals:

• Restore ROM beyond 90°
• Begin neuromuscular activation
• Maintain lower extremity mobility

Updated Restrictions:

• Brace unlocked as tolerated in therapy
• PROM may exceed 90° as tolerated
• Maintain TTWB status

Exercises:

• Continue Phase I exercises
• Begin hamstring sets
• Toe and heel raises
• Increase intensity of balance series
• Double knee bends (as tolerated)
• Bike with both legs – no resistance
• Aquajogging (gentle)

Cardiovascular:

• Bike with both legs (no resistance)
• Aquajogging
• Treadmill – walking on incline (7%)

Phase III – Progressive Strengthening (Weeks 7–12)

Goals:

• Build lower extremity strength
• Enhance neuromuscular control
• Initiate dynamic movements

Updated Restrictions:

• May transition to FWB if cleared at Week 6
• Gradual brace weaning

Exercises:

• Continue all prior mobility and strengthening drills
• Begin resistance on bike
• Add elliptical trainer
• Double leg bridges
• Reverse lunges (static hold)
• Resistance cord work
• Balance squats
• Single leg deadlifts
• Leg press (light resistance)
• Rowing machine
• Swimming with fins
• Stair stepper

Phase IV – Advanced Strengthening and Return to Impact (Weeks 13–20)

Goals:

• Improve dynamic stability
• Prepare for return to athletic drills
• Normalize strength and gait pattern

Exercises:

• Increase resistance and reps for all previous exercises
• Initiate running progression:
• Single-plane drills (Week 12–16)
• Multi-directional progression (Week 16–20)
• Functional sports test training begins
• Advanced balance and plyometric drills

Cardiovascular/Agility:

• Outdoor biking
• Hiking
• Snowshoeing

Phase V – Return to Sport and High-Level Activities (Weeks 20–24+)

Goals:

• Full strength, endurance, and coordination
• Return to unrestricted activity or sport

Exercises:

• Final stages of agility training
• Functional sports test completion
• High-level recreational activities:
• Golf
• Skiing
• Basketball
• Tennis
• Football
• Soccer