MPFL Reconstruction

Candidates for MPFL reconstruction typically include individuals who have experienced recurrent patellar dislocations or subluxations. People with an anatomical defect that predisposes them to patellar instability, such as a high-riding patella (patella alta) or a shallow groove for the patella on the femur (trochlear dysplasia), may also be candidates.

First, a graft is prepared to be used as the reconstructed ligament. Typically this is from a donor (allograft) but can be autograft as well. Then, a knee arthroscopy is performed through two small incisions to inspect the knee and determine if any additional procedures for the cartilage are needed. Two additional small incisions are made, one right on the front of the kneecap, and one on the inside of the knee. Two anchors are placed in the patella to hold the graft, and it is attached to them using suture, and to the femur using another anchor, replacing the damaged MPFL.

Recovery time can vary depending on the individual and their specific job or sport. Light activities and desk jobs can typically be resumed after a few weeks. However, a full return to high-impact sports or heavy labor may take several months, allowing adequate time for healing and physical therapy to restore strength and function.

You will recover from anesthesia for an hour or two before going home. After surgery, you can expect to use crutches and wear a knee brace for protection. You’ll likely experience some pain and swelling, which can be managed with medication and physical methods like icing and elevation.

Physical therapy is essential to regain mobility, strength, and function in your knee.

• Early Stage (Weeks 1-4): The focus is on controlling swelling, pain management, and restoring range of motion.
• Middle Stage (Weeks 4-12): During this period, weight-bearing is gradually increased, and exercises are done to improve strength and stability.
• Late Stage (Weeks 12 and beyond): This final phase includes sport or activity-specific exercises, agility drills, and balance training to help you return to your pre-injury activity levels.

Like any surgery, MPFL reconstruction carries certain risks, although they are generally low:

• Infection: As with any surgery, there is a risk of infection, although it’s quite rare (less than 1%). Antibiotics are given during surgery to minimize this risk.
• Blood clots: These are also rare, occurring in less than 1% of patients. You will be given aspirin to take for a month after surgery to reduce this chance.
• Nerve damage: This is also very rare, but could potentially lead to numbness or weakness in the leg or knee.
• Failure of the graft or re-dislocation: This occurs in approximately 5-10% of cases. Often this is due to some other risk factors that may need a larger surgery to correct such as a tibial tubercle osteotomy (TTO) or trochleoplasty.

If you decide against surgery when an MPFL reconstruction is recommended, potential risks can include:

• Recurrent knee instability and dislocation: This can lead to repeated injuries and could limit your ability to participate in certain activities or sports.
• Increased damage: Without intervention, the unstable patella can lead to damage to the cartilage of the patella or the knee joint, leading to arthritis.