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MPFL RECONSTRUCTION FOR A DISLOCATING KNEECAP

Method
Anatomical reconstruction of the MPFL to stabilise the kneecap
Duration
60 minutes
Recovery time
4 to 6 months

How does an MPFL reconstruction work?

MPFL reconstruction (medial patellofemoral ligament) is a well-established surgical technique for stabilising the kneecap where it dislocates repeatedly. The MPFL is the most important ligament holding the kneecap on its inner side. In a dislocation this ligament often tears, which can lead to chronic instability.

During the operation the torn MPFL is replaced – usually by one of the patient's own tendons (for instance the semitendinosus or gracilis tendon), which is fixed between the thigh bone and the kneecap. The aim is to reproduce the course of the ligament anatomically, so that the kneecap is held permanently on its track.

The tendon is taken in a minimally invasive way, passed through anatomically positioned bone tunnels and fixed there with absorbable screws or anchors. The operation is usually arthroscopically assisted and can be combined with further procedures (for instance a medialising transfer of the tibial tuberosity or a trochleoplasty where the shape is markedly abnormal).

Rehabilitation after an MPFL reconstruction

Aftercare proceeds in stages, with the aim of a reliable, pain-free kneecap that can cope with sport. Physiotherapy adapted to the individual is essential.

Phase I (0-4 weeks): protection and mobilisation
  • Knee orthosis with movement limited (0-30 degrees)
  • Partial weight-bearing with forearm crutches
  • Manual lymphatic drainage, cooling
  • Early functional mobilisation exercises (for instance CPM)
Phase II (5-8 weeks): building up load
  • Weaning off the orthosis, progression to full weight-bearing
  • Active movement and muscle-building exercises
  • Exercise-bike cycling, balance exercises
Phase III (from week 9): functional training
  • Co-ordination, strengthening, making movement automatic
  • Sport-specific loading (from about 4 months)
  • Return-to-sport testing before clearance