MPFL reconstruction

FAQs on MPFL Reconstruction in Gilbert, Chandler & Mesa AZ

 

The medial patellofemoral ligament or MPFL reconstruction is a widely used procedure to overcome recurrent lateral patellar instability. The high-success rate and creation of MPFL restraint without iatrogenic complications and abnormal biomechanics make the procedure a preferred choice.

What is MPFL reconstruction?

MPFL reconstruction is a surgical technique to restructure the medial patella-femoral ligament, which prevents the dislocation of kneecap or patella. The ligament acts like a rope to keep hold of the kneecap and prohibit its excess outward movement. However, this band of tissue gets ruptured, torn, or damaged when excessive blow or knee twisting results in partial or complete patellar dislocation.

MPFL reconstruction involves removing damaged medial patella-femoral ligament and reconstructing it using a graft obtained from hamstring tendons. In many cases, a cadaver graft is also used. The procedure is performed in an arthroscopic surgery.

What is medial patellofemoral ligament? How is it damaged?

The medial patellofemoral ligament is responsible to prevent lateral displacement of the kneecap, which is located inside the femoral groove. However, direct blow or twisting injury to the knee force thigh muscles to contract suddenly causing patella subluxation or dislocation. This also overstretches and ruptures the ligament that is attached to the inner side of the kneecap on one end and the femoral end on the other.

Once damaged, the medial patellofemoral ligament becomes weak and this leads to frequent kneecap dislocations causing pain and restricting knee movements. MPFL reconstruction is found to be help in treating severe patellar instability.

Who is a candidate for MPFL reconstruction?

A patient requires MPFL reconstruction when

  • He has recurrent kneecap dislocation or subluxation
  • Chronic kneecap instability
  • No major damage to his or her trochlear groove
  • No relief despite using non-surgical methods for long

How is MPFL reconstruction performed?

The patient undergoes MPFL reconstruction with general anesthesia. A tiny incision is made on the front portion of the knee and a hamstring tendo is removed from the thigh through this keyhole.

A new ligament is prepared from this tendon.

 

An arthroscopy is carried on the knee joint. Another tiny keyhole is drilled on the inner side of the kneecap and it is extended to the patella. The graft is inserted through this tunnel and fixed using sutures.

 

A third incision is created on the inner side and across the breadth of the femoral bone. The graft is pulled along the medial patellofemoral ligament and put into the femur tunnel. Surgeons fix it using sutures and screws. The wounds are closed and bandaged.

 

How long does MPFL reconstruction surgery take?

The entire procedure takes between 1 and 2 hours.

Do I need to stay at the hospital after MPFL reconstruction?

The procedure is mostly performed as a day surgery. You are discharged after a brief observation period. However, the knee can be very painful and it is suggested to stay overnight under the supervision of hospital staff.

 

What are the restrictions following MPFL reconstruction?

  • Keep the bandage clean and dry
  • Avoid putting water on the incision area for 72 hours
  • Use crutches for a week
  • Use a knee stabilizing brace for 6 to 8 weeks
  • Take prescribed pain and anti-inflammatory medications
  • Ice the knee for first 4-5 days
  • Take 1-2 week off from work

What kind of rehabilitation is needed following MPFL reconstruction? 

Start physiotherapy after two weeks. Until then do mild knee compression and motion to tighten muscles. After two weeks start light weight workouts, but put full weight bearing while in brace after 4 weeks. You can start partial wall squat and kinesthetic training after 5 weeks.

Join therapeutic workouts, such as soleus and hamstring stretches, hip flexion, extension, and abduction, biking, limb control, and low resistance training, from the 6th week and continue until the 8th week.

Start weight bearing from the 8th week and continue progressively until the fourth month. Also do hamstring curls, step ups, leg press, and controlled lateral movement.

From 4 to 6 months, do workouts intended to strengthen quadriceps and the functional ability as well as your activity requirement.

How long is the recovery period following MPFL reconstruction?

The procedure has above 90% success rate. It requires you to take a week or two off from work. You start feeling considerable improvement after 6 to 8 weeks and return to full activity-level after six months. But a full return to original strength and sports takes about 9 months.

What are the potential complications of MPFL reconstruction?

There is small risk of complications, including anesthesia allergy, numbness in the knee, infection, and blood clots.

 

References

Carmont Michael R, et al. Medial patellofemoral ligament reconstruction: a new technique. BMC Musculoskelet Disord. 2007 Feb 28; 8: 22.

LeGrand AB, et al. MPFL reconstruction. Sports Med Arthrosc. 2007 Jun;15(2):72-7.

Amis AA et al, Anatomy and Biomechanics of the Medial Patellofemoral Ligament, Knee 2003, 10: 215-220.

Desio SM, Burks RT, Bachus KN, Soft Tissue Restraints to Lateral Patellar Translation in the Human

Nomura E, Inoue M, Surgical Technique and Rationale for Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation, Arthroscopy 2003, 19, issue 5: 47e,

Steensen RN, et al.The Anatomy and Isometry of the Medial Patellofemoral Ligament: Implications for Reconstruction, Am J Sports Med 32: 1509-1513, 2004.

Mologne TS, Friedman MJ. Arthroscopic anterior cruciateligament reconstruction with hamstring tendons: Indications, surgical technique and complications and their treatment. In: Scott WN, editor. Surgery of the knee. 4. Philadelphia: Churchill Livingstone; 2006. pp. 648–651.

Fernandez E, Sala D, Castejon M. Reconstruction of the medial patellofemoral ligament for patella instability using a semiteninosus autograft. Acta Orthop Belg. 2005;71:303–308

Smirk C, Morris H. The anatomy and reconstruction of the patellofemoral ligament. The Knee. 2003;10:221–227.

Sandmeier, H.; Burks, R.T., et al. (2000). “Effective Reconstruction of the Medial Patellofemoral Ligament on Patellar Tracking.” American Journal of Sports Medicine 28: 345-349.

JOIN OUR E-MAIL LIST!