This protocol is a general guide to combined MPFL TTO rehabilitation. The time scales are an approximate guide and may be altered depending on various factors such as pain, swelling and muscle control. Pain along the MPFL graft and osteotomy graft site is relatively common for up to 4 months postoperatively and should not prevent participation in rehabilitation. The patient’s management should be tailored to meet individual objectives.
The MPFL is reconstructed using a hamstring graft. It is attached in the medial femoral condyle with a screw, there is a drill hole through the patella, and attached laterally with an endobutton.
The tibial tubercle is osteotomised and distalised/medialized to either:
Rehabilitation aims to protect the MPFL reconstruction in the early stages and to maximise the range of motion, strength and function.
Please check the post-operative notes for any variation in management.
Inflammatory stage. No initial blood supply to the graft.
Address any fear-avoidance issues—reiterate the importance of the patient taking responsibility for increasing ROM and function
Clinic review at 2/52 for removal of sutures and X-ray. The graft is at its weakest at 6/52.
The graft goes starts the process of revascularization and ligamentisation.
Exercises need to be tailored to their functional aim.
Clinic review at 4/12 the osteotomy site should be united and confirmed on X-ray.
By 3 months the graft fixation is consolidated. At 4 months there is complete revascularization of the graft, laying down of collagen and gradual increase in strength.
2/52, 6/52, 16/52, 1 year