MEDIAL PATELLOFEMORAL LIGAMENT (MPFL) RECONSTRUCTION
The kneecap (patella) is a small bone in the front of the knee that helps support the extensor mechanism (quadriceps and patellar tendons). As the knee bends, the patella glides along a groove on the femur bone – the trochlea. Patellar instability refers to a condition in which the patella slides out of the trochlea (dislocates). When the patella dislocates, a strong ligament on the inside of the knee (the medial patellofemoral ligament – MPFL) tears completely. Although the MPFL can partially heal without surgery, patients who sustain a patella dislocation are at a high risk of dislocating the patella in the future. In those patients who do not improve with non-surgical management, Dr. Welch may recommend surgical intervention.
The goal of MPFL surgery is to stabilize the patella and prevent it from dislocating. The most reliable way to restore stability is to use a graft (healthy tissue from another location) to reconstruct the MPFL. There are multiple techniques for MPFL reconstruction, and Dr. Welch typically employs a “bone tunnel” technique. During surgery, Dr. Welch makes an incision on the inside of the knee and identifies the spots on the inside of the femur bone and inside of the patella bone where the torn ligament should attach. Dr. Welch then creates small tunnels in the bone at the correct spots. The donor tissue is then placed in the bone tunnels under appropriate tension and is fixed to the tunnels with medical screws.
Following surgery, full weight-bearing is encouraged in a hinged knee brace. Dr. Welch also recommends intermittent icing, straight leg raises for quad strength, and starting a dedicated physical therapy protocol two weeks after surgery. The physical therapist focuses on reducing swelling in the knee, range of motion, and restoring strength to the core, hip, and thigh muscles. Dr. Welch recommends advancing the physical therapy program to cutting, pivoting, and sport-specific activities only after the patient has achieved certain goals (including appropriate quadriceps strength and appropriate range of motion). Most patients start sport-specific training approximately four months after surgery. Most patients return to competitive sports approximately six months after surgery. It is very important to follow the rehabilitation process carefully to achieve the best outcome.