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.
When is surgery necessary?
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:
- Repeated patellar dislocation or subluxation
- Poor patellar movement over the knee joint (maltracking)
- Chronic anterior knee pain
- Arthritis or tendonitis
The decision to operate
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.
Helping you understand your options
Before deciding to go ahead with surgery, Dr. Letchford will take the time to discuss your options with you, including:
- The outcome you want
- The risks and benefits of surgery
- The results you can expect
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.
About the procedure
What it involves
- Based on the anaesthetist’s recommendation, you will be given either general or spinal anaesthesia (put to sleep or numbed from the waist down).
- An incision is made over your kneecap, or the procedure can be performed via arthroscope.
- The relevant tendon is harvested and prepared for grafting.
- The patella is prepared to receive the graft.
- The graft is sutured into place on your patella, taking care to ensure it is correctly located and not impinging on any of the bones in your knee or thigh.
- Dr. Letchford will test the graft under tension and make sure the knee has good motion and stability.
- The incisions are closed. Dr. Letchford may apply a brace for stability.
Hospital stay and recovery time
In-patient stay: 1-2 days
Walk (aided): Immediately
Walk (unaided): 1-2 weeks
Driving: 6 weeks
Possible risks and complications
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.
- Existing medications
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.
- Medical evaluation
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 evaluation
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.
- Further tests and blood work
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.
Recovery, rehabilitation and precautions
- Physiotherapy and exercise
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.
- Preventing infection
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.
- Preventing blood clots
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.