From the Research
The post-operative protocol for medial patellofemoral ligament (MPFL) reconstruction should involve an accelerated rehabilitation approach without immobilization or weight-bearing restrictions, as it does not increase the risk of recurrent patellar dislocation or poorer patient-reported outcomes, as shown in the study by 1.
Key Components of the Protocol
- Pain management using NSAIDs like ibuprofen (400-600mg every 6-8 hours) or naproxen (500mg twice daily) along with prescribed opioids if needed for breakthrough pain
- Weight-bearing allowed as tolerated with crutches and a knee brace locked in extension for the first 1-2 weeks, but without strict weight-bearing restrictions
- Range of motion exercises beginning immediately but limited to 0-90 degrees for the first 2-3 weeks to protect the graft
- Physical therapy starting within the first week, focusing on quadriceps activation, straight leg raises, and gentle patellar mobilization
- Progression to partial weight-bearing with the brace unlocked during ambulation and increase range of motion as tolerated at 2-4 weeks
- Discontinuation of the brace and beginning of closed-chain strengthening exercises by 4-6 weeks
- Return to light jogging around 3 months, with sport-specific training at 4 months, and full return to sports at 5-6 months when quadriceps strength reaches at least 85% of the contralateral limb
Monitoring and Complications
- Patients should be monitored for complications such as persistent pain, effusion, or patellar instability throughout the rehabilitation process
- The rehabilitation protocol should be tailored to each patient's needs and progress, with adjustments made as necessary to ensure proper healing and prevent excessive stress on the reconstructed ligament
Evidence-Based Recommendations
- The study by 1 provides evidence that an accelerated rehabilitation protocol without immobilization or weight-bearing restrictions does not increase the risk of recurrent patellar dislocation or poorer patient-reported outcomes
- The study by 2 highlights the variability in online rehabilitation protocols after MPFL reconstruction, emphasizing the need for a standardized and evidence-based approach
- The study by 3 demonstrates the effectiveness of using suture tape for MPFL reconstruction, with good midterm clinical results and low complication rates