Surgical success does not end in the operating room; long-term joint stability and functional recovery depend directly on adherence to postoperative guidelines during the initial 6 months. Graft-to-bone incorporation and muscular re-education require systematic protection and progressive rehabilitation to prevent recurrent patellar instability.
Immediate Postoperative Care and Positioning
- Limb Elevation: Keep the leg elevated above heart level using pillows placed beneath the ankle and calf. Avoid placing pillows directly under the popliteal fossa (knee crease), as resting in knee flexion promotes hamstring contracture, joint stiffness, and extension deficit.
- Brace Protocol: Wear the hinged knee brace locked at $0^\circ$ of extension during ambulation and sleep for the first 2 to 3 weeks. Incremental flexion settings ($0^\circ\text{–}30^\circ$, $0^\circ\text{–}60^\circ$, up to $90^\circ$) are adjusted under clinical supervision.
- Cryotherapy & Medication: Apply cold therapy for 15 to 20 minutes every 2 to 3 hours. Take prescribed multimodal analgesics, anti-inflammatories, and oral anticoagulants (for DVT prophylaxis, typically continued for 2 to 4 weeks).
- Wound Hygiene: Keep surgical dressings clean and dry. Waterproof coverings are required for showering until sutures or staples are removed and incisions have completely re-epithelialized. Submersion in baths or pools is strictly prohibited.
Weight-Bearing and Sleeping Positions
- Weight-Bearing: Toe-touch to partial weight-bearing with crutches and the brace locked in extension begins on postoperative days 1–2, transitioning to full weight-bearing by weeks 4–6 as vastus medialis obliquus (VMO) control recovers.
- Sleep Guidelines: Sleep in a supine position (on the back) with the limb elevated. After 2 weeks, side-sleeping on the uninjured side is permitted with a pillow placed between the knees to maintain neutral alignment.
Crucial Activities and Movements to Avoid
- No Unprotected Ambulation: Do not walk without the brace or discontinue crutches prematurely.
- No Deep Squatting or Cross-Legged Sitting: Avoid deep knee flexion ($>90^\circ$) and sitting on the floor, which place high compressive loads across the patellofemoral joint.
- No Premature Driving: Driving is restricted for 4 to 6 weeks for right-leg surgery (or 1 to 2 weeks for left-leg surgery in automatic vehicles, provided opioid analgesics are discontinued).
- No Heavy Lifting: Avoid lifting objects $>5\text{ kg}$ during the first 6 weeks.
Early Home Exercises (Days 1–14)
- Ankle Pumps: Perform 20–30 repetitions hourly while awake to enhance venous return and reduce DVT risk.
- Isometric Quadriceps Sets: Tighten the anterior thigh muscles, pushing the back of the knee downward against the bed for a 5-second hold (10–15 reps, 3 times daily).
- Straight Leg Raises (SLR): Perform active straight leg raises only with the hinged brace locked in full extension to prevent graft strain.
Functional Recovery Timeline
| Milestone | Expected Postoperative Window |
| Sedentary / Desk Work | 2–3 weeks (with limb elevation) |
| Gait Normalization (Weaning Crutches) | 4–6 weeks |
| Stationary Cycling & Swimming | 8–12 weeks |
| Straight-Line Jogging | 4–5 months |
| Pivoting & Contact Sports | 6–9 months (after functional pass criteria) |
Red-Flag Symptoms Requiring Urgent Evaluation
Contact your surgical team or proceed to the emergency department if you experience:
- Temperature $> 38.3^\circ\text{C}$ with rigors.
- Spreading erythema, severe warmth, or purulent wound discharge.
- Sudden, asymmetric calf pain, swelling, and localized tenderness (suspected DVT).
- Acute chest pain, tachycardia, or sudden shortness of breath (suspected PE).
- A sensation of mechanical buckling, popping, or kneecap slippage.
Frequently Asked Questions: Postoperative Instructions Following Patellar Dislocation Surgery
When can I begin bearing weight and walking after patellar dislocation surgery?
Weight-bearing as tolerated (WBAT) with crutches is generally initiated on postoperative day 1 or 2, provided your hinged knee brace is locked in full extension (0°). Locking the brace protects the newly reconstructed MPFL graft from shear forces. Crutches are gradually weaned off between weeks 3 and 6 once you can perform an active straight leg raise without quadriceps lag and walk without a limp.
What is the correct resting and sleeping position for my leg after surgery?
Maintain your leg in a straight position inside the locked brace during sleep and resting periods. Elevate the leg by placing pillows beneath the calf and ankle so the knee rests above the level of your heart. Never place a pillow directly behind the knee joint, as prolonged resting in flexion causes capsular tightness, hamstring shortening, and permanent loss of terminal extension.
How should I manage and adjust the hinged knee brace?
The hinged knee brace serves as the primary external stabilizer during graft incorporation:
- Keep the brace locked at 0° for all walking, standing, and sleeping during the initial 2 to 4 weeks.
- Hinge angles are adjusted incrementally (typically 0°–30° for weeks 1–2, 0°–60° for weeks 3–4, and 0°–90° for weeks 5–6) under the direct supervision of your physical therapist.
- Wear the brace continuously, removing it only for hygiene and structured passive range-of-motion exercises.
How should I care for my surgical incisions and when can I shower?
Proper wound care prevents infection and supports clean scar formation:
- Keep all surgical dressings clean and dry until your first postoperative follow-up visit.
- Showering is generally permitted after 48 to 72 hours, provided the knee is sealed with a waterproof covering.
- Pat the incision sites dry gently with a clean towel; do not scrub or apply unapproved creams or antibiotic ointments.
- Avoid soaking the knee in bathtubs, hot tubs, or swimming pools until the incisions have fully closed and sutures are removed.
What is the recommended protocol for managing postoperative pain and swelling?
Manage pain and inflammation using a multimodal approach:
- Take prescribed analgesics on a consistent schedule during the first 48 to 72 hours rather than waiting for pain to peak.
- Apply cryotherapy (ice packs wrapped in a cloth) for 15 to 20 minutes every 2 to 3 hours.
- Keep the leg elevated above heart level whenever sitting or lying down.
- Avoid prolonged standing or sitting with the foot dependent on the floor to reduce gravity-induced fluid pooling.
What medications will I need to take at home after discharge?
Your discharge prescription typically includes:
- Thromboprophylaxis (Blood Thinners): Low-molecular-weight heparin injections or oral anticoagulants taken daily for 2 to 4 weeks to prevent deep vein thrombosis (DVT).
- Analgesics and NSAIDs: For pain relief and inflammation reduction to support early rehabilitation.
- Gastroprotective Agents & Stool Softeners: To prevent stomach irritation and counteract opioid-induced constipation.
Which early home exercises should I start immediately after surgery?
Initiate gentle activation exercises from day one to maintain circulation and prevent muscle inhibition:
- Ankle Pumps: Move your foot up and down 20–30 times every hour to encourage calf venous return.
- Quadriceps Sets: Tighten your front thigh muscle, flattening the back of the knee against the bed for 5 seconds (10–15 reps, 3 times daily).
- Patellar Mobilization: Gently glide the kneecap side-to-side and up-and-down (as instructed) to prevent fibrous adhesions.
When is it safe to resume driving after patellar stabilization surgery?
Return-to-driving timelines depend on the operative leg and transmission type:
- Left Knee (Automatic Transmission): Permitted after 1 to 2 weeks once narcotic medications are completely discontinued and sitting comfort is achieved.
- Right Knee: Prohibited for 4 to 6 weeks until the brace is unlocked for walking, quadriceps strength is restored, and rapid brake-reaction time is verified.
What is the timeline for returning to desk work, physical labor, and sports?
Functional progression proceeds through the following milestones:
- Sedentary / Desk Work: 2 to 3 weeks (ensuring regular leg elevation throughout the workday).
- Stationary Biking & Swimming: 8 to 12 weeks once active knee flexion exceeds 100°–110°.
- Straight-Line Jogging: 12 to 16 weeks after achieving adequate quadriceps symmetry.
- Pivoting & Competitive Sports: 4 to 6 months following objective functional testing (>90% limb symmetry).
What warning signs require immediate contact with the surgical team?
Seek prompt medical attention if you develop any of the following red-flag symptoms:
- Oral temperature higher than 38.3°C (101°F) or persistent chills.
- Rapidly increasing redness, warmth, or tense swelling around the knee.
- Active bleeding or purulent drainage from the incision sites.
- Severe, worsening pain in the calf muscle that does not subside with elevation.
- Sudden chest pain, difficulty breathing, or rapid heart rate (signs of potential pulmonary embolism).
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