Understanding MPFL Reconstruction
If you’ve experienced repeated instances of your kneecap (patella) slipping out of place, usually to the outside of your knee, causing pain, swelling, and a feeling of instability, you likely have patellar instability. If conservative treatments haven’t prevented these dislocations, your doctor might recommend an MPFL Reconstruction. This surgery aims to stabilize your kneecap by rebuilding a key ligament that holds it in place.
What’s Going On with Your Kneecap and MPFL?
Your kneecap (patella) normally glides smoothly in a groove at the end of your thigh bone (femur) as you bend and straighten your knee. It’s held in this groove by several structures, including muscles and ligaments. One of the most important ligaments for preventing the kneecap from dislocating to the outside is the Medial Patellofemoral Ligament (MPFL). This ligament runs from the inner side of your thigh bone to the inner edge of your kneecap.
A patellar dislocation occurs when your kneecap completely slips out of its groove. This often happens due to:
- Twisting injuries: Especially with the foot planted and the knee slightly bent.
- Direct trauma: A blow to the kneecap.
- Anatomical factors: Some people are born with a shallower groove, a higher kneecap, or differences in limb alignment that make them more prone to dislocations.
When the kneecap dislocates, the MPFL is almost always stretched or torn. If the MPFL doesn’t heal well or is repeatedly injured, the kneecap can become chronically unstable, leading to recurrent dislocations, pain, and a feeling of apprehension during activities.
How Does MPFL Reconstruction Help?
MPFL reconstruction is a surgical procedure designed to replace the torn or stretched MPFL with a new, healthy tendon graft. The goal is to create a strong, new ligament that firmly holds the kneecap in its groove, preventing future dislocations and improving stability.
This procedure is typically performed through a small incision on the inner side of your knee, sometimes with the assistance of arthroscopy (using a small camera) to check the joint.
During the surgery, the surgeon will:
- Obtain a Graft: A tendon (graft) is taken from another part of your own body (an autograft, often from your hamstring) or sometimes from a donor (an allograft). This graft will become your new MPFL.
- Prepare the Knee: Small tunnels or attachment points are created on the inner side of your thigh bone (femur) and the inner edge of your kneecap (patella) in the precise locations where the original MPFL attached.
- Insert and Secure the Graft: The new tendon graft is threaded through these prepared points and then secured with screws or other fixation devices. The surgeon carefully tensions the new ligament to ensure it holds the kneecap firmly in its groove without being too tight.
In some cases, if other anatomical factors are significantly contributing to the instability (like a very shallow groove or issues with limb alignment), additional procedures might be performed at the same time as the MPFL reconstruction to further enhance stability.
Life After MPFL Reconstruction:
After your MPFL reconstruction, physical therapy is absolutely essential for a successful recovery and to regain the full stability, strength, and function in your knee. This rehabilitation process is structured to protect the newly reconstructed ligament while gradually restoring movement and strength. Your physical therapist will guide you through a structured, progressive program, which typically includes:
- Protecting the Repair: Initially, your knee will likely be in a brace (often locked in extension) to protect the new ligament. Crutches will be necessary for a period to limit weight-bearing.
- Gradual Movement Restoration: You’ll begin gentle, controlled exercises to slowly regain the range of motion in your knee, being careful to avoid positions that put stress on the healing ligament.
- Progressive Strengthening: Your therapist will introduce strengthening exercises for your quadriceps, hamstrings, glutes, and calf muscles. These muscles are vital for supporting the kneecap and overall knee stability.
- Balance and Proprioception Training: Exercises to improve your balance and your body’s awareness of your knee’s position in space, which is crucial for preventing re-injury.
- Functional and Sport-Specific Training: For active individuals, the later stages of rehab involve drills to restore agility, jumping, landing, and cutting abilities, progressing safely back to sports and demanding activities.
Recovery from MPFL reconstruction is a significant process that requires patience, dedication, and strict adherence to your physical therapy program. Following your therapist’s instructions closely is crucial for achieving the best possible outcome and safely returning to your desired activities with a stable and confident kneecap.