 
Massachusetts General Brigham Sports Medicine 
Rehabilitation Protocol for MPFL Reconstruction 
 
This protocol is intended to guide clinicians through the post-operative course for MPFL reconstruction. This protocol is 
time based (dependent on tissue healing) as well as criterion based. Specific intervention should be based on the needs 
of the individual and should consider exam findings and clinical decision making. The timeframes for expected outcomes 
contained within this guideline may vary based on surgeon’s preference, additional procedures performed, and/or 
complications. If a clinician requires assistance in the progression of a post-operative patient, they should consult with 
the referring surgeon. 
 
The interventions included within this protocol are not intended to be an inclusive list. Therapeutic interventions should 
be included and modified based on the progress of the patient and under the discretion of the clinician.  
 
Considerations with concomitant procedures: 
Many different factors influence the post-operative MPFL reconstruction rehabilitation outcomes, including additional 
procedure such as tibial tuberosity osteotomy (TTO). It is recommended that clinicians collaborate closely with the 
referring physician regarding early range of motion, weight bearing status, and use of assistive devices.  
 
Post-operative considerations:   
If you develop a fever, excessive drainage from incision, severe heat and/or redness along incision, uncontrolled pain, or 
any other symptoms that concern you please call your doctor. 
 
PHASE I: IMMEDIATE POST-OP (0-2 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Protect surgical site 
• Reduce swelling, minimize pain 
• Restore full extension, gradually improve flexion ≥90 deg 
• Minimize arthrogenic muscle inhibition, re-establish quad control, regain full active extension 
• Patient education 
• Keep your knee straight and elevated when sitting or laying down. Do not rest with a 
towel placed under the knee 
Weight Bearing 
Walking 
• Initially brace locked, PWB (0-1 week) → WBAT with crutches (per MD recommendation) 
• May start walking without crutches as long as there is no increased pain, effusion, and proper 
gait 
• When climbing stairs, make sure you are leading with the non-surgical side when going up the 
stairs, make sure you are leading with the crutches and surgical side when going down the stairs 
Interventions 
Swelling Management 
• Ice, compression, elevation (check with MD re: cold therapy) 
• Retrograde massage  
• Ankle pumps 
 
Range of motion/Mobility 
• PROM  
• Heel slides with towel 
• Low intensity, long duration extension stretches: prone hang, heel prop 
• Seated hamstring/calf stretch 
 
Strengthening 
• Calf raises 
 
 
• Quad sets 
- NMES high intensity (2500 Hz, 75 bursts) supine knee extended 10 sec/50 sec, 10 
contractions, 2x/wk during sessions—use of clinical stimulator during session, 
consider home units distributed immediate post op 
• Straight leg raise 
- **Do not perform straight leg raise if you have a knee extension lag 
• Hip abduction 
• Standing hamstring curl 
Criteria to 
Progress 
• Knee extension ROM 0 deg 
• Quad contraction with superior patella glide and full active extension 
• Able to perform straight leg raise without lag 
 
PHASE II: INTERMEDIATE POST-OP (3-6 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Continue to protect surgical site 
• Maintain full extension, restore full flexion (contralateral side) 
• Normalize gait 
• Patient education 
Weight Bearing 
Walking 
• WBAT: May unlock brace when able to perform straight leg raise without lag  
• Discontinue use of brace after 6 wks (or per surgeon) and when gait is normalized 
Additional 
Interventions 
*Continue with 
Phase I 
interventions 
Range of motion/Mobility 
• Stationary bicycle 
• Gentle patellar mobilizations: superior/inferior and medial/lateral *Not necessary unless 
stiffness present 
 
Strengthening 
• Adductor strengthening: hook lying ball squeezes, SLR adduction, bridging with ball squeeze 
• Ball squats, wall slides, mini squats from 0-60 
 
Balance/proprioception 
• Single leg standing balance (knee slightly flexed) static progressed to dynamic and level 
progressed to unsteady surface 
Criteria to 
Progress 
• No swelling (Modified Stroke Test) 
• Flexion ROM > 90 deg  
• Extension ROM equal to contra lateral side 
 
PHASE III: LATE POST-OP (7-12 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Continue to protect surgical site 
• Maintain full ROM 
• Safely progress strengthening  
• Promote proper movement patterns 
• Avoid post exercise pain/swelling 
• Avoid activities that produce pain at repair site 
Weight Bearing 
• FWB without assistive device 
Additional 
Interventions 
*Continue with 
Phase I-II 
Interventions  
Range of motion/Mobility 
• Gentle stretching all muscle groups: prone quad stretch, standing quad stretch, standing hip 
flexor stretch 
 
Cardio 
• ~8 weeks: Elliptical, stair climber, flutter kick swimming, pool jogging 
 
Strengthening 
• Gym equipment: leg press machine, seated hamstring curl machine and hamstring curl machine, 
hip abductor and adductor machine, hip extension machine, roman chair, seated calf machine 
 
 
 
**The following exercises to focus on proper control with emphasis on good proximal stability 
• Proximal Strengthening: Double leg bridge, bridge with feet on physioball, single leg bridge, 
lateral band walk, standing clamshell/fire hydrant, hamstring walkout, TA brace with UE and LE 
progression 
• Squat to chair 
• Lateral lunges 
• Romanian deadlift (single and double leg) 
• Single leg progression: single leg press, slide board lunges: retro and lateral, split squats, step 
ups and step ups with march, lateral step-ups, step downs, single leg squats, single leg wall 
slides/sit 
• Lateral band walks 
 
Balance/proprioception 
• Progress single limb balance including perturbation training 
Criteria to 
Progress 
• No effusion/swelling/pain after exercise 
• Normal gait 
• ROM equal to contra lateral side 
• Quad/HS/glut index ≥70%; HHD mean or isokinetic testing @ 60d/s 
 
PHASE IV: TRANSITIONAL (13-16 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Maintain full ROM 
• Safely progress strengthening  
• Promote proper movement patterns 
• Avoid post exercise pain/swelling 
• Avoid activities that produce pain 
Additional 
Interventions 
*Continue with 
Phase II-III 
interventions 
Strengthening 
• Progress intensity (weight) and volume (repetitions) of exercises 
 
Plyometric activities 
• Bilateral FWB plyometrics progressed to single leg plyometrics 
 
Balance/proprioception 
• Progress single limb balance including perturbation training 
 
Criteria to 
Progress 
• Clearance from MD and ALL milestone criteria below have been met 
• Functional Assessment 
- Quad/HS/glut index ≥80%; HHD mean or isokinetic testing @ 60d/s 
- Hamstring/Quad ratio ≥66% 
- Hop Testing ≥80% compared to contra lateral side, demonstrating good landing 
mechanics 
 
 
PHASE V: EARLY RETURN TO SPORT (3-5 MONTHS AFTER SURGERY) 
Rehabilitation 
Goals 
• Safely progress strengthening  
• Safely initiate sport specific training program 
• Promote proper movement patterns 
• Avoid post exercise pain/swelling 
• Avoid activities that produce pain at graft donor site 
Additional 
Interventions 
*Continue with 
Phase II-IV 
interventions 
Strengthening 
• Progress intensity (weight) and volume (repetitions) of exercises 
 
Interval running program 
- Return to Running Program 
 
 
 
Progress to plyometric and agility program (with functional brace if prescribed) 
- Agility and Plyometric Program 
Criteria to 
Progress 
• Clearance from MD and ALL milestone criteria below have been met 
• Completion jog/run program without pain/effusion / swelling 
• Functional Assessment 
- Quad/HS/glut index ≥95%; HHD mean or isokinetic testing @ 60d/s 
- Hamstring/Quad ratio ≥66% 
- Hop Testing ≥95% compared to contra lateral side, demonstrating good landing 
mechanics 
• Lysholm >90% 
• KOOS-sports questionnaire >90% 
• International Knee Committee Subjective Knee Evaluation >93 
• Psych Readiness to Return to Sport (PRRS) 
• Kujala > 90 
 
 
PHASE VI: UNRESTRICTED RETURN TO SPORT (6+ MONTHS AFTER SURGERY) 
Rehabilitation 
Goals 
• Continue strengthening and proprioceptive exercises 
• Symmetrical performance with sport specific drills 
• Safely progress to full sport 
Additional 
Interventions 
*Continue with 
Phase II-V 
interventions 
• Multi-plane sport specific plyometrics program 
• Multi-plane sport specific agility program 
• Include hard cutting and pivoting depending on the individuals’ goals 
• Non-contact practice→ Full practice→ Full play (~6-7 mo) 
 
Criteria to 
Progress 
• Last stage, no additional criteria 
   Revised 7/2021 
 
Contact 
Please email MGHSportsPhysicalTherapy@partners.org with questions specific to this protocol 
 
References: 
 
Saper MG, Fantozzi P, Bompadre V, et al. Return-to-sport testing after medial patellofemoral ligament reconstruction in adolescent athletes. Orthop J Sports 
Med 2019;7: 2325967119828953. 
 
Manske RC, Prohaska D. Rehabilitation following medial patellofemoral ligament reconstruction for patellar instability. Int J Sports Phys Ther 2017;12:494-
511. 
 
Cosgarea AJ, Johnson K, McGee TG, et al. Rehabilitation after medial patellofemoral ligament reconstruction. Sports Med Arthrosc Rev 2017;25:105-113. 
 
Clark D, Walmsley K, Schranz P, et al. Tibial tuberosity transfer in combination with medial patellofemoral ligament reconstruction: Surgical technique. 
Arthrosc Tech 2017;6:591-597. 
 
Hinckel BB, Gobbi RG, Kaleka CC, et al. Medial patellotibial ligament and medial patellomeniscal ligament: Anatomy, imaging, biomechanics, and clinical 
review. Knee Surg Sports Traumatol Arthrosc 2018;26:685-696. 
 
Ahmad CS, Lightsey HM, Popkin CA, et al. Rehabilitation variability following medial patellofemoral ligament reconstruction. Phys Sportsmed 2018;46:441-
448 
 
 
 
 
 
 
 
Return to Running Program 
 
This program is designed as a guide for clinicians and patients through a progressive return-to-run program. Patients 
should demonstrate > 80% on the Functional Assessment prior to initiating this program (after a knee ligament or 
meniscus repair). Specific recommendations should be based on the needs of the individual and should consider clinical 
decision making. If you have questions, contact the referring physician.  
 
PHASE I: WARM UP WALK 15 MINUTES, COOL DOWN WALK 10 MINUTES 
Day 
1 
2 
3 
4 
5 
6 
7 
Week 1 
W5/J1x5 
 
W5/J1x5 
 
W4/J2x5 
 
W4/J2x5 
Week 2 
 
W3/J3x5 
 
W3/J3x5 
 
W2/J4x5 
 
Week 3 
W2/J4x5 
 
W1/J5x5 
 
W1/J5x5 
 
Return 
to Run  
Key: W=walk, J=jog 
**Only progress if there is no pain or swelling during or after the run 
 
PHASE II: WARM UP WALK 15 MINUTES, COOL DOWN WALK 10 MINUTES 
Week 
Sunday 
Monday 
Tuesday 
Wednesday 
Thursday 
Friday 
Saturday 
1 
20 min 
 
20 min 
 
20 min 
 
25 min 
2 
 
25 min 
 
25 min 
 
30 min 
 
3 
30 min 
 
30 min 
 
35 min 
 
35 min 
4 
 
35 min 
 
40 min 
 
40 min 
 
5 
40 min 
 
45 min 
 
45 min 
 
45 min 
6 
 
50 min 
 
50 min 
 
50 min 
 
7 
55 min 
 
55 min 
 
55 min 
 
60 min 
8 
 
60 min 
 
60 min 
 
 
 
Recommendations 
• Runs should occur on softer surfaces during Phase I 
• Non-impact activity on off days 
• Goal is to increase mileage and then increase pace; avoid increasing two variables at once 
• 10% rule:  no more than 10% increase in mileage per week 
 
 
 
 
 
Agility and Plyometric Program 
 
This program is designed as a guide for clinicians and patients through a progressive series of agility and plyometric 
exercises to promote successful return to sport and reduce injury risk. Patients should demonstrate > 80% on the 
Functional Assessment prior to initiating this program. Specific intervention should be based on the needs of the 
individual and should consider clinical decision making. If you have questions, contact the referring physician.  
 
PHASE I: ANTERIOR PROGRESSION 
Rehabilitation 
Goals 
• Safely recondition the knee 
• Provide a logical sequence of progressive drills for pre-sports conditioning 
Agility 
• Forward run 
• Backward run 
• Forward lean in to a run 
• Forward run with 3-step deceleration 
• Figure 8 run 
• Circle run 
• Ladder  
Plyometrics 
• Shuttle press: Double leg
alternating leg
single leg jumps 
• Double leg:  
- Jumps on to a box
 jump off of a box
 jumps on/off box 
- Forward jumps, forward jump to broad jump 
- Tuck jumps 
- Backward/forward hops over line/cone 
• Single leg (these exercises are challenging and should be considered for more advanced 
athletes):  
- Progressive single leg jump tasks 
- Bounding run 
- Scissor jumps 
- Backward/forward hops over line/cone 
Criteria to 
Progress 
• No increase in pain or swelling 
• Pain-free during loading activities 
• Demonstrates proper movement patterns 
 
PHASE II: LATERAL PROGRESSION 
Rehabilitation 
Goals 
• Safely recondition the knee 
• Provide a logical sequence of progressive drills for the Level 1 sport athlete 
Agility 
*Continue with 
Phase I 
interventions 
 
• Side shuffle 
• Carioca 
• Crossover steps 
• Shuttle run 
• Zig-zag run 
• Ladder 
Plyometrics 
*Continue with 
Phase I 
interventions 
• Double leg:  
- Lateral jumps over line/cone 
- Lateral tuck jumps over cone 
• Single leg (these exercises are challenging and should be considered for more advanced 
athletes):  
- Lateral jumps over line/cone 
- Lateral jumps with sport cord 
Criteria to 
Progress 
• No increase in pain or swelling 
• Pain-free during loading activities 
• Demonstrates proper movement patterns 
 
 
 
 
PHASE III: MULTI-PLANAR PROGRESSION 
Rehabilitation 
Goals 
• Challenge the Level 1 sport athlete in preparation for final clearance for return to sport 
Agility  
*Continue with 
Phase I-II 
interventions 
• Box drill 
• Star drill 
• Side shuffle with hurdles 
Plyometrics 
*Continue with 
Phase I-II 
interventions 
• Box jumps with quick change of direction 
• 90 and 180 degree jumps  
Criteria to 
Progress 
• Clearance from MD 
• Functional Assessment 
- Quad/HS/glut index ≥90% contra lateral side (isokinetic testing if available) 
- Hamstring/Quad ratio ≥70% 
- Hop Testing ≥90% contralateral side 
• Patient Outcome Measures: 
- KOOS-sports questionnaire >90% 
- International Knee Committee Subjective Knee Evaluation >93 
- ACL-RSI 
 
 
 
