Patellofemoral ligament reconstruction rehabilitation program

• 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.