Knee knee arthroscopy protocol postop instructions and exercises knee plica excision protocol postop instructions and exercises knee anterior cruciate ligament acl reconstruction protocol postop instructions and exercises knee anterior cruciate ligament acl reconstruction with meniscus repair protocol postop instructions and exercises knee arthroscopy with. Mpfl repair reconstruction rehab protocol this protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames. Medial patellofemoral ligament mpfl reconstruction and proximal realignment assumptions. Cole,md,mba weight bearing brace rom exercises phase i 02 weeks as tolerated with brace on at all times during day and while sleeping off for hygiene 090 heel slides, quad and hamstring sets, patellar mobs, gastroc stretch, slr in brace, modalities. The medial patellofemoral ligament mpfl is reconstructed by securing an autograft cadaver semitendinosus hamstring from the patella to the anatomic femoral attachment site between the medial epicondyle and adductor tubercle. Rom exercises progress through passive, active and activeassisted rom as detailed above. Mpfl reconstruction postop protocol for daniel myer, m.
And you may have forgotten some of the information we discussed during our last visit, or forgot to ask. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury level of activity. Once the dressing is removed on the third postoperative day, ice is applied for 20minute periods 34 times per day. Immediate postop no passive extension or passive flexion exercises gentle arom or aarom knee flexion is permitted within md limitations usually 90 degree limit for the first 6 weeks and then slow rom progression as the capsular.
Reconstruction of the medial patellofemoral ligament using semitendinosus. Mpfl repairreconstruction protocol missouri orthopaedic institute weeks 46. Medial patellofemoral ligament reconstruction rehabilitation. This guideline is designed to progress the individual through rehabilitation to. Knee medial patellofemoral ligament reconstruction. This evidencebased mpfl reconstruction rehabilitation protocol is criterionbased. Knee knee arthroscopy protocol postop instructions and exercises knee plica excision protocol postop instructions and exercises knee anterior cruciate ligament acl reconstruction protocol postop instructions and exercises knee anterior cruciate ligament acl reconstruction with meniscus repair protocol postop instructions and exercises knee arthroscopy. Mpfl medial patellofemoral ligament mpfl reconstruction protocol initial pt evaluation and treatment begins postop day 2 weeks 06 weight bear as tolerated in hinged knee brace.
Medial collateral ligament and mpfl repair rehabilitation. Whether you or one of your family members or friends is considering knee mpfl reconstruction, or are scheduled for surgery, i understand this can be a stressful time. Medial patellofemoral ligament reconstructionrepair rehab. Ligament mpfl reconstruction rehabilitation protocol mirrors btb acl protocol week 1 limited activity with ice and elevation for five days to prevent hemarthrosis and minimize swelling wbat with crutches for five days for balance only. The doublebundle technique also effectively limits rotation throughout rom, helping to minimize postoperative instability. Medial patellofemoral ligament reconstruction protocol week 1. This ligament may be injured in a patella dislocation. This evidencebased mpfl reconstruction rehabilitation protocol is. Rehabilitation guidelines for mpfl reconstruction the intent of this protocol is to provide the clinician with a general guideline of the postoperative course of the patient that has undergone the above stated procedure. Medial patellofemoral ligament reconstruction rehabilitation protocol it is important to understand that all time frames are approximate and that progressions should be based on individual monitoring as well as type of surgery.
Questions if you have any concerns or questions after your surgery, during business hours call 7633022231. Rehabilitation guidelines for medial patellofemoral ligament repair and reconstruction the knee consists of four bones that form three joints. Patients must demonstrate specific functional criteria at each physical therapy visit before progressing to more advanced interventions. Rehabilitation of the knee after medial patellofemoral. An mpfl reconstruction creates a new ligament by replacing the torn mpfl with either a hamstring tendon autograft patients or an allograft donor tendon. Rehabilitation guidelines for medial patellofemoral ligament. The intent of this protocol is to provide the clinician with a guideline to establish and progress a patient through post operative rehabilitation. Fox valley orthopedics mpfl reconstruction hamstring autograft all surgeons.
Knee mpfl repair 1 overview this is a protocol that provides you with general information and guidelines for the initial stage and progression of rehabilitation according to the general timeframes. Mpfl reconstruction rehabilitation guideline sanford health. The femur is the large bone in the thigh and attaches by ligaments and a capsule to the tibia, the large bone in the lower leg commonly referred to as the shin bone. Medial patellofemoral ligament reconstructionrepair rehabilitation program phase 1. Mpfl reconstruction is a surgery in which a new medial patellofemoral ligament is created to stabilize the knee and help protect the joint from additional damage. An mpfl reconstruction creates a new ligament by replacing the torn mpfl with either a hamstring tendon. Feb, 20 medial patellofemoral ligament mpfl repair and reconstruction rehabilitation protocol phase i surgery to 6 weeks after surgery appointments o rehabilitation appointments begin 7 to 10 days after surgery and continue once every 10 to 14 days. Mpfl repairreconstruction rehab protocol this protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames. Medial patellofemoral ligament mpfl reconstruction protocol. Cole,md,mba weight bearing brace rom exercises phase i 02 weeks as tolerated with brace on at all times during day and while sleeping off for hygiene 090 heel slides, quad and hamstring sets, patellar mobs, gastroc stretch, slr in.
The medial patellofemoral ligament mpfl is a ligament on the medial apsect of the knee which helps stabilize the patella against lateral movement. Medial patellofemoral ligament reconstructionrepair rehab protocol description of procedure. The medial patellofemoral ligament mpfl is reconstructed. An early goal of rehabilitation after mpfl reconstruction is to reestablish full knee. Although mpfl tear is not the primary cause of instability. Wbat, brace locked at 0 degrees for ambulation and sleeping rom. The following is a protocol for postoperative patients following medial patellofemoral ligament. Pdf rehabilitation after medial patellofemoral ligament. Arthroscopic mpfl reconstruction rehab protocol benedict figuerres, md phase iimmediate postoperative phase weeks 02 date. David flanigan, md the ohio state university clinical orthopaedics columbus, oh the views expressed here are my own and not those of my employer. Patients with a traumatic cause usually have good quadriceps muscle bulk and control, good core strength and normal alignment. Modifications to this guideline may be necessary dependent on physician specific instruction, concomitant injuries or procedures performed. Medial patellofemoral ligament reconstruction repair rehab protocol description of procedure.
Abnormal anatomy, poor lumbopelvichip control, and quadriceps control. Keep postop brace locked in full extension for ambulation pwb sleep with brace locked in full extension o minimize pain and effusioncompression wrap, elevation, ice. The arthrex anatomic doublebundle technique for medial patellofemoral ligament mpfl reconstruction replicates the native shape of the mpfl and provides stability in both flexion and extension. Specific changes in the program will be made by the physician as appropriate for the individual patient. Mpfl repair reconstruction protocol missouri orthopaedic institute mpfl repairreconstruction rehabilitation protocol seth l. Brace use immediate wbat locked straight nwb full motion remove for sleeping after 1st postop appointment wb progressive unlocking of brace. Protect fixation and surrounding soft tissue control pain and inflammation regain active quadriceps contraction minimize adverse effects of immobilization. Rehabilitation guidelines for medial patellofemoral. Biomechanics the mpfl functions as a tether or leash stopping lateral movement of the kneecap during the first 30 degrees of flexion. Protect fixation and surrounding soft tissue control pain and inflammation regain active quadriceps contraction minimize adverse. It offers an excellent treatment option for people who have experienced more than one dislocation. Mpfl reconstruction british journal of sports medicine. But capsular andor infrapatellar fat pad contracture, quadriceps inhibition, and poorly positioned grafts can lead to the complications noted earlier.
A mpfl reconstruction surgery uses a ligament from somewhere else in the body to reconstruct this ligament stabilizing the patella. Manual therapy o flexion and extension 90 of flexion by 6 weeks. Soft tissue healing 46 weeks for vmo advancement proximal realignment to graft tendon to bone healing 12 weeks graft to bony attachments primary surgery. Medial patellofemoral ligament reconstructionrepair. Medial patellofemoral ligament reconstruction protocol. The result is usually a stretching andor tearing of the inner supporting structures, including the mpfl. The mpfl does not have a function once the patella engages in the trochlea. Mpfl reconstruction rehabilitation the following is a protocol for postoperative patients following medial patellofemoral ligament reconstruction.
This mpfl reconstruction protocol is criterion based. The current standard of care for surgical management of chronic lateral patellofemoral instability is mpfl reconstruction. Medial patellofemoral ligament reconstructionrepair rehab protocol. Rehabilitation guidelines for vmo advancempfl reconstruction. Frank, md team physician, university of colorado athletics assistant professor, department of orthopaedic surgery university of colorado school of medicine. Cryotherapy at least 4xday, ifc f or paineffusion, and nmes for quadriceps activation. It is by no means intended to substitute for ones clinical decision making regarding the progression of a patients post.
Patella mobilizations in superior, inferior, medial directions. It is not intended to be a substitute for ones clinical decision making. Exercises with the knee in flexion greater than 3045 degrees will not put strain on the mpfl reconstruction. Sep 01, 2015 the medial patellofemoral ligament mpfl attachment is defined in relation to the size of the medial femoral condyle. Patients will utilize a brace that will be locked at 0 deg during all weight bearing activities for the. Throughout this protocol, time references in weeks since surgery represent the earliest that a patient may. Physiotherapy rehabilitation after mpfl reconstruction requires careful monitoring by a physiotherapist. Mpfl ligament reconstruction with allograft rehab considerations.
Reconstruction and imbrication this protocol is designed to assist you with your rehabilitation after surgery and should be followed under the direction of. Medial collateral ligament and mpfl repair rehabilitation protocol. Medial patellofemoral ligament mpfl reconstruction, july 2019 2 patient information medial patellofemoral ligament mpfl reconstruction outside lateral aspect of the knee. It is designed for rehabilitation following medial patellofemoral ligament mpfl reconstruction. Mpfl repairreconstruction rehabilitation protocol seth l. The stitches are usually placed using an arthroscope small camera through a small incision. Work on flexion via passive flexion, aarom and heel slides.
Medial patellofemoral ligament reconstruction rehabilitation protocol. Rehabilitation guidelines for medial patellofemoral ligament repair. Wbat, brace locked at 30 degrees for ambulation and sleeping. An mpfl imbrication uses stitches to tighten the ligament. Medial patellofemoral ligament mpfl repair and reconstruction rehabilitation protocol phase i surgery to 6 weeks after surgery appointments o rehabilitation appointments begin 7 to 10 days after surgery and continue once every 10 to 14 days.
It has been suggested that in the majority of patellar dislocation cases, the medial patellofemoral ligament mpfl is disrupted with a high recurrence rate especially in female patients. Medial patellofemoral ligament mpfl reconstruction. Mpfl reconstruction protocol rehabilitation of the extensor mechanism after patellar stabilization surgery is based on an appropriate understanding of lower limb mechanics, anatomy, and careful evaluation of the individual patient. Medial patellofemoral ligament reconstruction rehabilitation protocol weightbearing brace range of motion exercises phase 1 02 weeks as tolerated in brace on at all times during day and while sleeping off for hygiene and exercises 090 calf pumps, quadriceps tightening sets and slr in brace, heel slides and patellar mobilization out of. Mpfl reconstruction is an operation to correct for lateral patellar instability. Mpfl repairreconstruction protocol missouri orthopaedic institute mpfl repairreconstruction rehabilitation protocol seth l. Tamara l young, atc, otc, med department of sports medicine diagnosis.
Postoperative rehabilitation guidelines for mpfl reconstruction rehab protocol 02 weeks. Medial patellofemoral ligament reconstruction technique for patellofemoral instability as described by. Rehabilitation goals o protection of the postsurgical knee o restore normal knee range of motion. While the postop dressing is in place, icing should be done continuously. Mpfl reconstruction using hamstring tendon passed through a double patellar transverse bony tunnel technique is a safe, reliable management option for recurrent patellar dislocation in patients without any predisposing anatomic factors. Wulf, md medial patellofemoral ligament mpfl repair and. Patients will utilize a brace that will be locked at 0 deg during all weight bearing activities.
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