Patella Stabilisation Surgery Rehabilitation Protocol

(MPFL Reconstruction ± Tibial Tuberosity Transfer ± Trochleoplasty)

Patella Stabilisation Surgery Rehabilitation Protocol

Rehabilitation Philosophy

This protocol is criteria-based, biologically informed, and anatomy-driven, designed to optimise recovery following patella stabilisation surgery while protecting soft-tissue reconstructions and/or bony realignment procedures.

Timelines are guides only, progression is dictated by surgical procedure(s) performed, tissue healing, radiographic union (where applicable), symptom response, and functional control, not time alone.

Key Biological Considerations

  • MPFL reconstruction is a soft-tissue procedure and load-sensitive early

  • Tibial tuberosity osteotomy (TTO) introduces a bone-healing constraint

  • Trochleoplasty requires protection of cartilage, bone, and trochlear remodelling

  • When procedures are combined, the most restrictive structure governs rehabilitation

Clinical Governance & Escalation

Recurrent apprehension, effusion, focal bony pain, loss of extension, worsening anterior knee pain, or failure to progress warrants immediate load modification and review with Dr Lynskey.

View all Rehabilitation Protocols

Procedure-Specific Rules (Non-Negotiable)

MPFL Reconstruction

Key Rehab Limiter: Graft protection, medial restraint healing

MPFL Reconstruction + TTO

Key Rehab Limiter: Bone healing is rate-limiting

Trochleoplasty

Key Rehab Limiter: Bone + cartilage healing, patellofemoral load tolerance

When procedures are combined, follow the most restrictive protocol elements.

Preoperative Phase (Prehabilitation)

Goals

  • Full knee extension

  • Quadriceps activation (VMO not isolated)

  • Hip abductor and trunk strength

  • Education regarding:

    • Bracing

    • Weight-bearing restrictions

    • Longer protection phase if osteotomy/trochleoplasty planned

Phase 1 – Protection & Early Control (0–6 Weeks)

Goals

  • Protect surgical reconstruction(s)

  • Maintain full knee extension

  • Control pain and swelling

  • Prevent quadriceps inhibition

  • Establish safe patella tracking

Weight Bearing

  • MPFL alone: WBAT in brace (as directed)

  • MPFL + TTO / Trochleoplasty: NWB → PWB as directed
    (Bone healing governs progression)

Brace

  • Hinged knee brace typically locked in extension initially

  • Range progression per surgeon instructions

Rehabilitation Focus

  • Immediate knee extension work (heel props)

  • Controlled knee flexion progression

  • Quadriceps sets, SLRs (brace on if lag present)

  • NMES if inhibition persists

  • Hip and core strengthening

  • Patellar glides (gentle medially directed)

  • Upper-body and contralateral limb conditioning

Avoid

  • Lateral patellar stress

  • Open-chain resisted knee extension early

  • Deep knee flexion

  • Pivoting or torsional load

Criteria to Progress

  • Full extension maintained

  • Effusion controlled

  • Good quadriceps activation

  • No instability or apprehension

Phase 2 – Controlled Loading & Gait (6–12 Weeks)

(Requires procedure-appropriate clearance)

Goals

  • Restore functional ROM

  • Normalise gait

  • Improve limb alignment and control

  • Maintain patella stability

Rehabilitation Focus

  • Progress weight bearing when cleared

  • Closed kinetic chain strengthening:

    • Sit-to-stand

    • Mini-squats

    • Step-ups (low height)

  • Stationary cycling

  • Balance and proprioceptive training

  • Hip abductor and trunk emphasis

  • Avoid valgus collapse and femoral IR

Additional Rules

  • If TTO or trochleoplasty performed:
    Progressive loading only after radiographic evidence of union

Criteria to Progress

  • Non-antalgic gait

  • Minimal effusion

  • Controlled knee flexion under load

  • No patellar apprehension

Phase 3 – Strength & Capacity (3–6 Months)

Goals

  • Restore limb strength

  • Improve neuromuscular control

  • Increase functional tolerance

Rehabilitation Focus

  • Progressive resistance training

  • Step-down control

  • Frontal and transverse plane control

  • Endurance conditioning

  • Gradual exposure to sport-specific patterns (non-impact initially)

Phase 4 – Advanced Function (6–9+ Months)

Goals

  • Restore higher-level functional capacity

  • Prepare selected patients for recreational sport

Rehabilitation Focus

  • Higher-load functional strengthening

  • Directional and frontal-plane control drills

  • Low-level plyometrics only once radiographic union is confirmed and control is excellent

Phase 4 – Advanced Function (6–9+ Months)

Goals

  • Restore higher-level function

  • Prepare for selected sport or occupational demands

Rehabilitation Focus

  • Higher-load strengthening

  • Directional change drills

  • Controlled deceleration

  • Plyometrics only once bone healing confirmed (if applicable)

Return To Activity (Criteria-Based)

Required Criteria

  • Stable patella without apprehension

  • Full extension, functional flexion

  • Minimal or no effusion

  • Independent, non-antalgic gait

  • Adequate strength and control for task demands

  • Radiographic union if TTO or trochleoplasty performed

Typical Timeframes (Guide Only)

  • Return to sport: 4–6 months, procedure-dependent

  • Impact sports often delayed or modified in trochleoplasty patients

Surgical Notes VBJS

  • Bone healing is the rate-limiting step when osteotomy is performed

  • Recurrent swelling or apprehension is not normal

  • Temporary muscular discomfort is expected; focal bony pain is not

  • Modify rehabilitation for:

    • Trochlear dysplasia severity

    • Cartilage procedures

    • Adolescents or borderline skeletal maturity

  • Any concern regarding stability, healing, or regression warrants review with Dr Lynskey

Key Clinical Message

Patella stabilisation rehabilitation is anatomy-driven, not generic.
Movement quality, alignment control, and respect for healing structures determine long-term success.

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