MPFL Reconstruction

Overview
The medial patellofemoral ligament (MPFL) is an important stabilizing structure on the inside of the knee. It helps keep the kneecap (patella) properly aligned and prevents it from sliding or dislocating to the outside. When the MPFL is torn — often due to a patellar dislocation — the knee can feel unstable, and there is a higher risk of future dislocations. MPFL reconstruction restores stability by rebuilding the damaged ligament, helping prevent future dislocations and allowing patients to return to an active lifestyle.

Factors Influencing MPFL Reconstruction Success
Several factors can affect the success of MPFL reconstruction:

• Kneecap alignment: If there are underlying issues like patella alta (a high-riding kneecap) or abnormal alignment of the leg, these may need to be addressed at the same time.

• Condition of the cartilage: Damage to the cartilage behind the kneecap can affect recovery and long-term knee health.

• Patient factors: Younger, active patients tend to recover well, especially if they follow post-surgery rehabilitation closely.

The Shift Toward Early Stabilization
In the past, many patients were treated non-surgically after a first-time patellar dislocation. However, newer research has shown that early surgical stabilization with MPFL reconstruction can reduce the risk of recurrent dislocations, especially in patients with risk factors like loose ligaments or bone structure issues. The goal is to restore stability early to protect the knee from further injury and cartilage damage.

The Procedure
MPFL reconstruction is typically performed as an outpatient surgery using small incisions. A new ligament is created using a tendon graft, which can come from either the patient’s own tissue (autograft) or from a donor (allograft). The graft is secured to the kneecap and the thigh bone (femur) to recreate the natural position of the MPFL. Special care is taken to place the graft in the correct position to restore normal kneecap tracking.

Graft Choice: Autograft vs. Allograft
When performing MPFL reconstruction, your surgeon will choose between an autograft (using your own tendon) or an allograft (using donor tissue). Studies have shown that both graft types provide equally successful outcomes. In our practice, we often recommend an allograft to avoid the additional incision and potential discomfort at the graft harvest site. This helps reduce post-operative pain and speeds up the recovery process.

Addressing Associated Issues
Sometimes, injuries from kneecap dislocation go beyond the torn ligament. It’s not uncommon for the cartilage on the back of the kneecap to be damaged during the dislocation. If this is the case, additional procedures to repair or restore the cartilage may be recommended at the same time as MPFL reconstruction.

In some patients, especially those with significant alignment problems, additional bone procedures may be necessary to fully correct the instability. These include:

• Tibial Tubercle Osteotomy (TTO): Repositioning the bony bump on the shinbone to improve kneecap alignment and tracking.

• Coronal Plane Osteotomy: Realigning the thigh bone or shinbone to better distribute forces across the knee and relieve pressure on the kneecap.

Your surgeon will carefully evaluate these factors using imaging and physical examination to create a personalized surgical plan.

Recovery Process

• Initial Phase (0–6 Weeks): The knee is usually placed in a brace, and weight-bearing is gradually introduced as tolerated. Physical therapy focuses on gentle range of motion and reducing swelling.

• Intermediate Phase (6–12 Weeks): Therapy progresses to strength-building exercises and improving knee control.

• Advanced Phase (3–6 Months): Focus shifts to more advanced strengthening, balance, and functional activities. Many patients return to sports or full activities around 4–6 months, depending on progress.

Risks and Considerations

• Risk of re-dislocation, though much lower after reconstruction.

• Knee stiffness or loss of motion if rehabilitation is not followed properly.

• Graft failure or loosening over time.

• Rare risk of pain at the graft harvest site if an autograft is used.

• Possibility of needing additional procedures to address cartilage damage or alignment concerns.

Conclusion
MPFL reconstruction is a highly effective surgery to restore kneecap stability and help prevent future dislocations. If you have experienced a kneecap dislocation and want to explore your treatment options, contact our office for a full evaluation and personalized care plan.