Patellar Stabilization with Tibial Tubercle Transfer and MPFL Reconstruction with Allograft

POSTOP REHABILITATION PROTOCOL:

TIBIAL TUBERCLE TRANSFER AND MPFL RECONSTRUCTION

Range of motion goals: 0-90 degrees week 2, 0-120 degrees by week 4, full flexion by week 6.

PHASE I: weeks 0-6

Weeks 0-2:

Goals:

Control pain and inflammation
Protect fixation and soft tissues
Regain quadriceps and VMO Control.
Brace: range of motion knee brace locked in extension for walking and sleeping, unlock while sitting
Range of motion: limit 0-90 deg
Weight bearing: touch down weight bearing – foot flat
Exercises:
Quadriceps sets
Hamstring isometrics
Straight leg raises in four planes with brace locked in extension
Non-weight bearing gastoc-soleus and hamstring stretches
Resisted ankle range of motion with therabands
Patellar mobilization when tolerated – Only medial, superior and inferior, Not lateral
ROM exercises – heel slides, seated knee flexion, prone dangle, passive resting extension with heel prop
Modalities:
Heat before
Ice after activities
Quadriceps stim – NMES to promote muscle activation

Weeks 2-6:
Brace: range of motion knee brace locked in extension for ambulating and sleeping
Range of motion: increase to 0-90 deg by end of week 2. 120 degrees by week 4, full flexion by week 6.
Weight bearing: partial weight bearing with crutches

Exercises:
Continue above exercises:

As above
Proprioception/Balance
Isometrics

Phase II: weeks 6-12

ONLY progress to Phase II if patient has no signs of active inflammation, a good quadriceps set and appropriate amount of allowed flexion

Goals:

Increase range of motion to full
Avoid over-stressing fixation
Increase quadriceps and VMO control for restoration of proper patellar tracking
Weeks 6-8:
Brace: keep locked in extension while ambulating and sleeping until patient shows adequate quadriceps control (usually minimum of 8 weeks)
Range of motion: slowly increase range of motion to goal of full flexion by 10-12 weeks
Weight bearing: if shows radiographic signs of healing, then will progress to weight-bearing as tolerated with brace locked in extension
Exercises:
Continue Phase I exercises
Balance and proprioceptive exercises
SLRs without brace
Weight bearing gastroc-soleus stretches
Stationary bike with low resistance and high seat position to decrease patellofemoral joint compression forces

Weeks: 8-12
Brace: May discontinue brace only after radiographic bone healing and good, active control of the knee are demonstrated; may DC crutches
Range of motion: progress to full range of motion

Exercises:

Step-ups
Closed kinetic chain terminal knee extension with resistive tubing or weight machine
Hamstring curls
Toe raises
Leg press from 0-45 deg of flexion
Flexibility and proprioception exercises
Progress to moderate resistance on stationary bike
Begin treadmill walking

PHASE III: 4 months to 6 months

Goal:

Good to normal quadriceps strength
No evidence of patellar instability
No Soft tissue complaints
Normal gait pattern

Exercises:

Open and closed kinetic chain strengthening
Pool running program
Increase walking difficulty and intensity of treadmill, bike, and elliptical trainer – But no jogging, no running and no single or double legged hop
Only after 5 months – start to introduce light jog, patient must have quadriceps girth 50% of opposite leg
Work on proprioceptive activities

PHASE IV: 6 months to 1 year