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:

• Toe-touch weight bearing (TTWB) for 6 weeks
• PROM limited to 0°–90°
• Brace locked in full extension (0°)

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 during therapy sessions
• PROM may exceed 90° as tolerated
• Continue TTWB

Exercises:

• Continue all Phase I exercises
• Hamstring sets
• Toe and heel raises
• Advance balance series
• Double knee bends
• Bike with both legs – no resistance

Cardiovascular:

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

Phase III – Progressive Strengthening (Weeks 7–12)

Goals:

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

Restrictions:

• Begin transition to weight bearing as tolerated after Week 6
• Gradual brace weaning

Exercises:

• Double leg bridges
• Reverse lunge – static hold
• Resistance cord work
• Balance squats
• Single leg deadlifts
• Leg press (light)

Cardiovascular:

• Bike with resistance
• Elliptical trainer
• Swimming with fins
• Rowing machine
• Stair stepper

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

Goals:

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

Exercises:

• Running progression – single plane (Weeks 12–16)
• Advance to multi-directional running (Weeks 16–20)
• Functional sports test training
• Outdoor biking, hiking, snowshoeing

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

Goals:

• Return to unrestricted activity or sport
• Optimize endurance, coordination, and control

Activities:

• Final stages of agility training
• Functional sports test
• Golf
• Skiing
• Basketball
• Tennis
• Football
• Soccer