The Medial Patello-Femoral Ligament (MPFL) is a ligament on the inside of the kneecap that connects it to the quadriceps muscle. When this ligament is torn, ruptured or otherwise damaged, the kneecap can go out of joint.
MPFL reconstruction surgery restores stability to the knee by replacing the MPFL with a hamstring tendon, preventing the kneecap from repeatedly going out of joint and/or the knee dislocating. Surgery is usually recommended when a severe injury is sustained, or when a loose body or other disorder is detected.
This surgery is typically undertaken in high-level athletes, or in patients who otherwise engage in high levels of activity.
Surgery is only considered if non-surgical treatment has failed to stabilise the knee and kneecap, and if knee dislocation is becoming a common problem.
Physiotherapy is usually the first option when treating patellar instability; however if this does not yield results after extended treatment, surgery might be the better option.
Symptoms that could necessitate surgery include:
The decision to operate will be made based on Dr. Letchford's analysis of your history, physical examinations, and x-ray, MRI and CT scans.
Physical examinations will include inspecting your knee's alignment and the way the patella tracks over the knee.
Before deciding to go ahead with surgery, Dr. Letchford will take the time to discuss your options with you, including:
Dr. Letchford will only recommend surgery if both you and he agree that it offers the best possible outcome for reducing your pain or mobility issues, and for restoring your desired activity levels post-surgery.
In-patient stay: 1-2 days
Walk (aided): Immediately
Walk (unaided): 1-2 weeks
Driving: 6 weeks
Arthroscopic surgery for MPFL reconstruction is a relatively low-risk procedure, however there are possible complications associated with the surgery.
Complications include fracture of the patella, pain or stiffness in the knee, or the development of arthritis in the knee. Other surgical risks include infection, blood clots, and allergic reactions to medications.
Before you come in for your surgery, there are a number of things that both you and Dr. Letchford will need to do to ensure everything goes smoothly before, during and after the operation.
You should cease taking any blood-thinning or anti-inflammatory drugs, as well as any herbal or natural remedies you're taking, at least a week before your surgery.
You will undergo a routine medical examination to make sure you are in good enough health for the operation, and to identify any factors that might cause problems down the line, including body weight and existing infections or skin conditions.
Dental work can introduce bacteria into the bloodstream. To protect against the chance of developing an infection, please have any dental work done well before or after your surgery. You may need to take preventative antibiotics for a few months to a few years after your surgery to protect against the risk of infection.
You will be sent for routine blood work to confirm you are healthy enough to undergo surgery. We may also perform heart checks or additional scans if the need arises.
It is recommended that you stop smoking for as long as possible before your surgery, as it can encourage clots while hampering circulation and oxygenation of the blood.
Physiotherapy will play a large part in your recovery after MPFL reconstruction surgery. Your physiotherapist will give you exercises to perform to help regain the ability to fully bend the knee. Sports or any other intense activity should be avoided for a few months, or according to your physiotherapist's recommendation.
Make sure you change your dressing as instructed, and keep an eye out for any changes, including fever, chills, tenderness, excessive fluid, or increased pain, as these can indicate infection.
You will be given a combination of anti-clotting drugs and pressure bandages to help prevent clots from forming. If you notice any shortness of breath or unexplained pain, contact a doctor immediately.
For more information on what to expect from your Medial Patello-Femoral reconstruction surgery, please take a moment to read through the resources available at the American Academy of Orthopaedic Surgeons website.