After MPFL reconstruction (surgery to rebuild the ligament that holds the kneecap in place), most people wear a brace and use crutches for the first few weeks, reach about 90 degrees of bend in the first 4 to 6 weeks, and have close to full bend by around 2 to 3 months. Jogging usually starts at around 3 to 4 months.
Return to sport takes about 6 to 9 MONTHS, and on average around seven. More than 8 in 10 people get back to their sport, and about 2 in 3 return at the same level as before.
Protocols vary a lot between surgeons, especially if bone work was done at the same time. Your surgeon’s protocol comes first. Use theirs.
Month by month
- Weeks 0 to 2: brace on, usually locked straight for walking. Crutches. Focus on a fully straight knee, waking up the thigh muscle and controlling swelling. Gentle bending as your surgeon allows
- Weeks 2 to 6: bend gradually opened up toward 90 degrees. Many people come off crutches and out of the locked brace somewhere in this window
- Weeks 6 to 12: normal walking, full or near-full bend, stationary bike, and strength work for the thigh and hip. Balance exercises on one leg
- Months 3 to 6: jogging once you can squat on one leg and hop without pain. Then jumping, landing and change-of-direction drills, easy to hard
- Months 6 to 9: return to pivoting and contact sport once you pass strength and hop tests
The brace and crutches
- Why a brace: it protects the new ligament while it heals and the thigh muscle is weak. Early on it is usually locked straight for walking and unlocked for exercises
- How long: anywhere from about 2 to 6 weeks, depending on your surgeon and on whether bone work was done
- Weight bearing: after an MPFL reconstruction on its own, many surgeons let you put as much weight through the leg as is comfortable from day one, in the brace, with crutches for balance
- If the bone was moved too: some people also have the bony bump below the knee moved to change the kneecap’s line of pull (a tibial tubercle osteotomy). Weight bearing is then usually limited for longer while the bone heals
- Coming off crutches: when you can walk without a limp. Limping on purpose to “save” the knee slows recovery
Bend targets
- Get it straight first. A knee that won’t go fully straight makes walking hard work and holds back everything else
- 90 degrees in the first 4 to 6 weeks is a common target. Some surgeons ask you not to force bend past 90 in the first few weeks to protect the graft
- Full bend by around 2 to 3 months for most people
- Progress over perfection. A few degrees more each week is on track. Stalled for two weeks is worth mentioning
The ligament is rebuilt in an afternoon. Trusting the kneecap takes months of work.
What rehab builds
- Thigh strength: the quadriceps (front of thigh) guides the kneecap. Weak quads are a common reason people feel unsteady long after the ligament has healed
- Hip strength: the muscles on the outside of the hip stop the knee from collapsing inward, which is the position the kneecap tends to slip out in
- Landing and cutting control: learning to land with the knee over the foot, not falling inward
- Confidence: fear of the kneecap slipping again is common and normal. Graded practice of the movements that scare you is part of rehab, not an extra
Return to sport
Time on its own is not the test. Most surgeons and physios look for:
- Strength close to the other leg, often at least 85 to 90 percent on testing
- Hop tests at a similar level on both legs
- No swelling after training
- Sport-specific drills done at full speed without pain or apprehension
- Clearance from your surgeon
The news after surgery is good. Only about 1 in 20 people dislocate again, compared with about 1 in 3 after a first dislocation treated without surgery. See kneecap dislocation for how the decision to operate is made.
The return-to-sport testing looks a lot like the testing after ACL surgery. See return to sport after ACL surgery for how those tests work.
Other common questions
- Driving: not usually before about 6 weeks. You need to be off crutches and able to brake hard
- Work: desk work often at around 6 weeks, physical work closer to 12
- A numb patch beside the scar is common and usually shrinks over months
- A sore back of the thigh if your graft came from a hamstring tendon. It settles as you strengthen
The Royal Orthopaedic Hospital, an NHS specialist hospital, has a clear patient guide to MPFL reconstruction that covers the same milestones.
Call your surgeon today if
- The kneecap slips out or you feel a clunk and the knee swells quickly afterward
- You suddenly can’t straighten the knee or lift your leg
- The wound is red, spreading, weeping or draining, or you have a fever or chills
- Your calf is painful, tender or newly swollen: possible clot in the leg
Go to the emergency department if
- You are suddenly short of breath or have chest pain. A clot can travel to the lung
- The kneecap is out of place and won’t go back. Don’t force it
Mention it at your next review if
- Bend is stuck well short of 90 degrees at around six weeks
- The knee still won’t go fully straight
- The kneecap feels unstable or you avoid certain movements months after surgery
- Aching at the front of the knee is limiting your training. It is sometimes runner’s knee rather than a problem with the graft
The ligament holds the kneecap. The muscles decide whether you trust it.