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Medial Patelofemoral Ligament Repair - Physical Therapy Protocol

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Preoperative Guidelines

  • Restore full AROM
  • Teach normal heel-toe gait
  • Strengthen involved extremity
  • Decrease effusion
  • Educate Patient on post-op protocol, use of crutches (level and stairs), importance of extension

Note: Exercise prescription is dependent upon the tissue healing process and individual functional readiness in all stages. If any concerns or complications arise regarding the progress of any patient, physical therapy will contact the orthopedist.


Phase I (Post-op Days 1 – 14)

  • Brace
    • Week 1: Locked in extension
    • Week 2: Locked at 0-20 degrees
  • Crutches – WBAT (D/C crutches when gait is WNL and SLR without lag x 30)
  • AROM, AAROM 0-20 degrees
  • GENTLE Patellar mobilization (teach patient)
  • Calf pumping
  • Passive extension with heel on bolster or prone hangs
  • Electrical stimulation in full extension with quad sets and SLR (if no extensor
    lag)
  • SLR x 4 (parallel bars if poor quad control)
  • Double leg heel raises
  • Well-leg stationary bike or UBE
  • Gentle HS stretching, calf stretching
  • Ice pack with knee in full extension after exercise


Goals: Pain/effusion controlled, No extensor lag, 0 degrees extension


Phase II (Weeks 3 – 4)

  • Brace
    • Week 3: 0-45 degrees
    • Week 4: 0-60 degrees
  • Crutches – D/C when gait is WNL
  • Continue appropriate previous exercises/patellar mobilizations
  • Scar massage when incision healed
  • AAROM, AROM 0-60 degrees
  • Standing Well-leg Theraband all directions
  • Single leg heel raises
  • Stretches – HS, AT, Hip Flexors, ITB


Goals: Normal heel-toe gait, Knee ROM 0-0-60 degrees


Phase III (Weeks 5 – 6)

  • Brace
  • Week 5: 0-75 degrees
  • Week 6: 0-90 degrees
  • Continue appropriate previous exercises
  • AROM, AAROM 0-90 degrees
  • Mini squats, weight shifts – in parallel bars
  • Short arc quads (light weight…if no retropatellar pain)
  • Mini squats– No flexion > 45 degrees
  • Leg press with light resistance, 0-45 degrees
  • Hamstring curls 0-45 – closed chain (carpet drags or rolling stool)
  • Pool therapy


Goals: Knee ROM 0-0-90 degrees, No effusion


Phase IV (Weeks 7 – 12)

  • Brace
    • Week 7: 0-105 degrees
    • Week 8: 0-120 degrees
    • Week 9: D/C brace
  • Continue appropriate previous exercises
  • PROM, A/AROM, AROM through full range
  • Partial wall squats – No knee flexion past 45 degrees
  • Lateral step-downs in parallel bars – No knee flexion past 45 degrees
  • Proprioceptive training – single leg standing in parallel bars, double leg BAPS for weight shift, progress to single leg BAPS, Plyoback, and Body Blade
  • Hamstring curls through full range
  • Stationary bike for progressive resistance and time
  • Stairmaster – low resistance with short steps only
  • Elliptical trainer
  • Treadmill – backwards and forwards walking…progress as tolerated


Goals – Full knee ROM, Walk 2 miles at 15 min/mile pace without pain or edema or effusion

Phase V (Months 3 – 4)

  • Continue appropriate previous exercises
  • Gym program
  • Progress Closed chain exercises by increasing weight and ROM
  • Functional activities – Fitter, slide board, figure 8s, gentle loops, large zigzags
  • Treadmill – Running progression program
  • Pool – Begin swimming laps
  • Quad stretches

Goals – Run 2 miles at normal pace


Phase VI (Months 5 – 6)

  • Home/gym program
  • Agility drills / Plyometrics
  • Continue strengthening, stretching, proprioceptive training, and running programs
  • Functional test at 6 months to clear for sports and discharge – Must have 90% of opposite leg
  • (single leg hop and 12 meter hop for time)


Goals: Return to all activities


No contact sports until 6 months post-op

 

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