Medial Patellofemoral Ligament Reconstruction (MPFL)
A procedure to restore stability and help prevent patellar dislocations in the knee
The MPFL is a key stabilising ligament that connects the kneecap to the inner side of the femur (thighbone). It plays a critical role in maintaining patellar alignment, particularly during movements involving bending or twisting of the knee.
Common Reasons for MPFL Reconstruction Surgery
- Recurrent patellar dislocations or subluxations (partial dislocations).
- Chronic instability of the kneecap that affects mobility and causes pain.
- Damage to the MPFL caused by trauma or sports-related injuries.
- Structural abnormalities of the knee, such as a high-riding patella (patella alta).
The primary goals of MPFL reconstruction are to stabilise the kneecap, alleviate pain, and improve knee function.
Preparation for Surgery
Preparation for MPFL reconstruction includes a detailed evaluation by Dr Ben McGrath, including imaging studies such as X-rays, MRIs, or CT scans to assess the condition of the ligament and identify any contributing factors to patellar instability.
Key Steps in Preparation:
- Consultation: Dr McGrath will explain the procedure, its potential benefits and risks, and answer any questions.
- Pre-Surgical Instructions: Patients may need to fast before surgery and adjust medications, such as stopping blood thinners.
- Prehabilitation: Strengthening the quadriceps muscles may improve recovery outcomes and reduce post-operative stiffness.
- Lifestyle Adjustments: Maintaining a healthy weight, stopping smoking, and addressing other health factors may enhance surgical success.
What Happens During the Surgery?
MPFL reconstruction is typically performed under general anaesthesia using minimally invasive techniques where possible.
Surgical Steps:
- Incisions: Small incisions are made near the inner side of the knee to access the MPFL and surrounding structures.
- Graft Selection: A graft, often harvested from the hamstring tendon or a donor source, is prepared to replace the damaged MPFL.
- Tunnel Creation: Small tunnels are drilled into the patella and femur to secure the graft.
- Graft Placement and Fixation: The graft is positioned to mimic the natural MPFL and secured using screws or anchors.
- Closure: The incisions are closed with sutures or adhesive strips, and the knee is bandaged for protection.
The procedure typically takes 1 to 2 hours, depending on the complexity of the injury.
Understanding the Risks
While MPFL reconstruction is generally safe and effective, it carries some potential risks:
- Infection: At the incision sites or within the joint.
- Graft Failure: Rarely, the reconstructed ligament may not provide the expected stability.
- Swelling and Stiffness: Temporary inflammation or reduced range of motion.
- Blood Clots: Rare but possible in the lower limbs.
- Knee Misalignment: Rare complications affecting patellar tracking.
Dr McGrath follows advanced surgical protocols to minimise these risks and ensure patient safety.
What to Expect After Surgery
Immediate Post-Operative Care:
- Pain Management: Mild to moderate discomfort can be managed with prescribed medications and regular icing.
- Assistive Devices: Crutches and a knee brace may be recommended to protect the reconstructed ligament during initial recovery.
- Discharge Instructions: Clear guidance on caring for the surgical site, activity restrictions, and follow-up appointments will be provided.
Rehabilitation and Recovery
Recovery from MPFL reconstruction involves a structured rehabilitation plan tailored to the patient’s needs:
Phase 1: Early Recovery (Weeks 0–6)
- Goals: Protect the graft, reduce swelling, and restore range of motion.
- Activities: Partial weight-bearing with crutches, gentle range-of-motion exercises, and cryotherapy.
Phase 2: Strength and Mobility (Weeks 6–12)
- Goals: Regain strength and stability in the knee.
- Activities: Physiotherapy for strengthening the quadriceps and hamstrings, light cycling, and balance exercises.
Phase 3: Advanced Recovery (Months 3–6)
- Goals: Restore full function and prepare for daily activities or sports.
- Activities: Progressive resistance training, functional drills, and agility exercises.
Long-Term Outcomes
MPFL reconstruction may help stabilise the kneecap, prevent recurrent dislocations, and improve knee function. Long-term success depends on:
- Adherence to rehabilitation guidelines.
- Regular follow-up appointments to monitor progress.
- Maintaining a healthy lifestyle to support joint health.
Most patients experience significant improvements in stability and mobility, allowing them to return to their desired activities with confidence.