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Patellofemoral ligament reconstruction rehabilitation program

General considerations

  • Patients are weight bearing as tolerated.
  • Crutch use as needed post-operatively for safety and to maintain good gait pattern and posture.
  • Can wean to single crutch or cane use, then to no assistive device once able to walk with normal, safe gait pattern and with confidence in involved leg.
  • Range of motion will be locked in full extension in a brace for 4 weeks.
  • In Therapy, progression of flexion for week one is 0-30 degrees, week two 30-60 degrees, week three to four progressing up to 90 degrees and adding passive range of motion to 90 degrees in home exercise program.
  • Important not to push for flexion past 90 degrees for first 4 weeks to protect repair.
  • NO PATELLAR MOBILIZATIONS FOR 4 WEEKS.
  • Regular attention to proper quadriceps recruitment and knee mechanics will optimize outcome.
  • Return to sport and activities are dependent upon passing a functional sports test.

Week 1

  • Nurse visit day 2 for dressing change, review of medications and instruction on a home program.

Manual

  • Effleurage for edema, gentle soft tissue mobilization.
  • Passive flexion should be limited to 0-30 degrees.

Exercises

  • Ankle pumps, quad-sets (every 30 mins), leg raises in multiple planes.
  • Extension stretching to hamstrings and calves to maintain extension range of motion.
  • Well-leg stationary cycling and UBE. Upper body weight machines and trunk exercises.
  • Initiate single-legged stance balance/coordination activities with fingertips on stable surface (kitchen counter-top).

Goals

  • Gait weight bearing as tolerated with brace locked in extension.
  • Passive range of motion 0-30 degrees.

Weeks 2 - 4

Exercises

  • Continue to progress weight bearing and functional mobility as able.
  • Progress balance and proprioception activities, add calf raises.

Manual

  • Continue with effleurage for edema, gentle soft tissue mobilization.
  • Passive flexion for WEEK TWO should be limited to 30-60 degrees of flexion, WEEK THREE and FOUR progress to 90 degrees. At this time, patient should be able to hang knee off of table twice a day for passive flexion at home.

Goals

  • Gait weight bearing as tolerated with brace locked in extension.
  • Passive range of motion 0-60 degrees by week 2, 0-90 degrees by week 4.

Weeks 4 - 6

  • M.D. visit at 1 month post-op.
  • Brace open without range of motion limitations for day-to-day activities and exercises.

Manual

  • Continue with soft tissue mobilization.
  • Begin gentle patellar mobilizations/ initiate scar mobilization after week 4.

Exercises

  • Light or no resistance stationary two-legged biking with high seat position without brace.
  • Progress knee bending stretches with self assisted technique (strap, other leg, wall, etc).
  • Light resistance leg press less than 90 degrees knee flexion, abduction/adduction hip machines at the gym.
  • Initiate weight shifting, short-arc knee bends, mini steps ups, and proprioceptive exercises.
  • Pool walking and workouts with brace locked in full extension as soon as incisions are well-healed.

Goals

  • Gait brace open, increase gait mechanics; wean off brace as able. Passive range of motion 0-105 degrees.

Weeks 6 - 8

Manual

  • Continue soft tissue, patellar, joint mobilizations as needed.

Exercises

  • Increase range of motion to full knee flexion.
  • Bicycling (stationary or road, no mountain biking) at normal seat height without brace.
  • Functional exercises should focus on eccentrics. Increase depth of knee bends and increase height of step-ups.
  • Continue to increase intensity and resistance of other exercises.

Goals

  • Passive range of motion full. Initiate stationary biking.

Weeks 8 - 12

  • Add lateral exercises (i.e. lateral stepping, lateral step-ups, etc.).
  • Continue all exercises with emphasis on closed-chain, functional and proprioceptive program.
  • Increase resistance of cycling, stair machine, and pool programs.

Goals

  • Initiate lateral movements.

Weeks 12 - 16

  • Initiate Sports Test I and running program.
  • Develop sport-specific exercises and training program.
  • Maximal eccentric focused strengthening program.
  • Begin light running program as able to demonstrate good strength and mechanics.

Goals

  • Initiate sport specific training. Increase strength, power, and cardiovascular conditioning.

Months 4 - 6

  • Goals are to develop maximal strength, power, and advance to sporting activities.
  • Resisted closed-chain rehabilitation through multiple ranges.
  • Running program, balance drills and agility program.

Goals

  • Initiate plyometrics.

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.

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