MPFL Reconstruction with Tibial Tubercle Osteotomy (Fulkerson)

Physical Therapy Protocol

Restrictions

Weight Bearing:

• Touch-down weight bearing (TTWB) for 6 weeks.
• Progress to 25% weight bearing weekly starting at week 6.
• Goal: Full weight bearing with normalized gait by weeks 8–10.

Bracing:

• Locked brace (0–0°) for 2 weeks, worn full-time including sleep.
• Unlock brace to 0–90° after 2 weeks for ROM exercises.
• Brace may be discontinued at 6 weeks if gait is normalized and quad control is adequate.

Range of Motion (ROM):

• 0–90° passive motion for first 2 weeks.
• Progress 10° per week thereafter until full ROM achieved.

Additional Precautions:

• Initiate gentle patellar mobilizations immediately post-op.
• Avoid resisted knee extension until cleared by physician.

Phase I – Protection Phase (Weeks 0–2)

Goals:

• Protect surgical repair.
• Minimize pain and inflammation.
• Prevent stiffness and quadriceps inhibition.

Interventions:

• Brace locked at 0° extension, worn at all times including sleep.
• TTWB with crutches.
• ROM: 0–90° passive motion at home.
• Exercises:
  • Calf pumps.
  • Quadriceps sets (in brace).
  • Straight leg raises (SLR) in brace.
  • Modalities for pain and swelling control.

Phase II – Progressive ROM and Early Strengthening (Weeks 2–6)

Goals:

• Achieve full passive extension.
• Progress flexion ROM gradually.
• Begin early muscular activation without compromising repair.

Interventions:

• TTWB continues.
• Brace unlocked to 0–90°, off at night starting week 2.
• Progress non-weight bearing flexibility.
• Exercises:
  • Floor-based core, hip, and gluteal strengthening.
  • Advance quadriceps sets, patellar mobilizations, and SLR out of brace when quad control is adequate.

Phase III – Weight Bearing Progression and Strengthening (Weeks 6–8)

Goals:

• Gradual weight-bearing progression to normalize gait.
• Improve lower extremity strength and stability.

Interventions:

• Progress weight bearing by 25% weekly to reach FWB by weeks 8–10.
• Discontinue brace if patient demonstrates normal gait mechanics.
• Begin closed chain quadriceps strengthening and balance activities.
• Initiate stationary biking (no resistance) at week 6.

Phase IV – Advanced Strengthening and Functional Training (Weeks 8–16)

Goals:

• Achieve full ROM and return to functional mobility.
• Build dynamic balance and core stability.

Interventions:

• Full weight bearing without assistive devices.
• Progress flexibility and strength exercises.
• Add elliptical and swimming after 14 weeks.
• Advance gluteal, pelvic stability, and core exercises.

Phase V – Return to Sport and High-Level Activities (Weeks 16–24)

Goals:

• Restore dynamic neuromuscular control and strength.
• Initiate sports-specific training once cleared by surgeon.

Interventions:

• Maximize single-leg balance and functional movements.
• Continue closed-chain quadriceps and core strengthening.
• Begin running progression and agility drills if cleared.
• Progress to high-level activities (e.g., golf, biking, light jogging) after 20–24 weeks.