Medial Patellofemoral Ligament (MPFL) Reconstruction Surgery
Stabilising the kneecap with MPFL reconstruction to prevent recurrent dislocations
The MPFL is a critical ligament that connects the inner edge of the kneecap to the femur (thigh bone). It plays a crucial role in preventing the kneecap from dislocating laterally (outwards). This ligament provides about 50-60% of the restraining force against lateral patellar displacement, making it essential for knee stability during activities that involve twisting, turning, or sudden stops.
Injury to the MPFL can occur when the patella dislocates or becomes subluxated (partially dislocated) often due to a sports injury or in some cases due to a twisting or pivoting event. These incidents are more common in patients with anatomic predispositions such as patella alta (a high kneecap), loose joints (ligamentous laxity) and a less constrained or flatter patellofemoral joint. People with these injuries are described as having patellar instability which can damage the medial patellofemoral ligament (MPFL), which stabilises the kneecap (patella)
MPFL INJURIES EXPLAINED
MPFL injuries typically occur during a patellar dislocation, where the kneecap moves out of its normal position. This can happen due to:
- Direct trauma to the knee
- Sudden twisting or pivoting movements
- Landing awkwardly from a jump
Symptoms of an MPFL injury include:
- Immediate pain at the time of injury
- A feeling of the kneecap “popping out” or dislocating
- Swelling around the knee
- Difficulty straightening or bending the knee
- Instability or giving way of the knee
INDICATIONS FOR MPFL RECONSTRUCTION SURGERY
MPFL reconstruction surgery is considered when non-surgical treatments, such as physiotherapy, bracing, and activity modification, do not adequately address knee instability or when recurrent patellar dislocations occur.
Surgery may be recommended if:
- You have a complete tear or severe damage to the MPFL
- You experience chronic knee instability that affects your daily activities or sports participation
- Non-surgical treatments have failed to improve your condition
THE MPFL RECONSTRUCTION SURGICAL PROCEDURE
MPFL reconstruction is a surgical procedure aimed at restoring knee stability by reconstructing the damaged ligament using a graft.
The procedure involves several key steps:
Anaesthesia: The surgery is performed under regional or general anaesthesia to ensure you are comfortable and pain-free.
Incisions: Small incisions are made around the knee to create entry points for the surgical instruments.
Graft Harvesting: A graft, typically taken from the hamstring tendon or a donor (allograft), is prepared. The choice of graft depends on individual patient factors and surgeon preference.
Graft Placement: Tunnels are drilled into the femur and patella at the original MPFL attachment sites. The graft is then threaded through these tunnels and secured with fixation devices such as screws or anchors.
Graft Tensioning and Fixation: The graft is tensioned appropriately to mimic the natural alignment and function of the MPFL. Proper tensioning is crucial to avoid over- or under-tightening, which could affect knee stability.
Closure: The incisions are closed with sutures or surgical staples, and the knee is dressed with sterile bandages.
POST-OPERATIVE EXPECTATIONS AFTER MPFL RECONSTRUCTION
Following MPFL reconstruction surgery, a structured rehabilitation program is essential for a successful recovery. Dr Martin will provide a personalised rehabilitation plan tailored to your specific needs and goals.
PAIN MANAGEMENT
Post-operative pain can be managed with medications, including analgesics and anti-inflammatories. Ice packs and elevation can also help reduce swelling and discomfort.
REHABILITATION AND PHYSIOTHERAPY
Physiotherapy will begin soon after surgery to restore knee movement, strengthen the muscles around the knee, and improve overall function.
The rehabilitation process typically includes:
- Early Phase (0-2 weeks): Focus on reducing swelling, regaining knee range of motion, and activating the quadriceps muscles.
- Intermediate Phase (2-6 weeks): Gradual increase in weight-bearing, strengthening exercises, and improving balance and proprioception.
- Advanced Phase (6 weeks onward): Progression to sport-specific drills, agility exercises, and gradual return to high-demand activities.
RECOVERY TIMELINE FOR MPFL RECONSTRUCTION SURGERY
Recovery from MPFL reconstruction varies depending on the individual and the extent of the injury. A general timeline includes:
- 0-2 weeks: Initial recovery with limited weight-bearing and focus on pain management.
- 2-6 weeks: Gradual increase in activity level and weight-bearing as tolerated.
- 6-12 weeks: Continued rehabilitation with strengthening and range of motion exercises.
- 3-6 months: Progressive return to sport-specific training and activities.
- 6-12 months: Full return to sports and high-demand activities, depending on individual progress and surgeon clearance.
UNDERSTANDING THE RISKS ASSOCIATED WITH MPFL RECONSTRUCTION SURGERY
While MPFL reconstruction is generally safe and effective, it is important to be aware of potential risks and complications:
Infection: Infections at the surgical site are possible but can be managed with antibiotics and proper wound care.
Bleeding and Blood Clots: As with any surgery, there is a risk of bleeding and blood clots (deep vein thrombosis).
Graft Failure: The graft used to reconstruct the MPFL may fail or become loose, potentially requiring revision surgery.
Knee Stiffness and Loss of Range of Motion: Post-operative stiffness can occur but is typically managed with physiotherapy.
Persistent Pain: Some patients may experience ongoing pain around the knee joint.
Nerve Damage: Nerves around the knee may be injured during surgery, leading to numbness or weakness.
MITIGATING THE RISKS
Dr Martin employs several strategies to mitigate the risks associated with MPFL reconstruction surgery:
Pre-Surgical Preparation: Ensuring optimal health and fitness before surgery can aid in recovery. Prehabilitation exercises to strengthen the muscles around the knee may also be beneficial.
Experienced Surgeon: Choosing a skilled and experienced orthopaedic surgeon like Dr Sam Martin can significantly impact the outcome of the surgery.
Post-Surgical Rehabilitation: Adhering to a structured rehabilitation program is crucial for recovery. Physiotherapy helps restore strength, flexibility, and function to the knee.
Patient Education: Understanding the limitations and realistic expectations post-surgery can help patients avoid re-injury and manage recovery effectively.
By following these guidelines and working closely with Dr Martin and your healthcare team, you can achieve a successful recovery from MPFL reconstruction surgery and return to your desired level of activity.
