York, ME (207) 363 3490 | Portsmouth, NH (603) 431 1121

20Hip Care
10Hip-Conditions and Injuries
Cartilage Injury
Femoroacetabular Impingement (FAI)
Gluteal Tears
Hamstring Tears
Hip Instability
Deep Gluteal Space Syndrome
Labral Tears
Psoas Impingement (Internal Snapping Hip)
PVNS
Trochanteric Bursitis
10Hip-Treatment and Surgeries
Acetabuloplasty
Chondroplasty
Femoroplasty
Gluteal Repair
Labral Debridement
Labral Reconstruction
Labral Repair
Nanofracture
Psoas Release
Trochanteric Bursa Debridement
33Knee Care
13Knee Conditions and Injuries
ACL Tear
Cartilage Injury
Discoid Meniscus
Lateral Meniscus Tear
LCL Injury
MCL Injury
Medial Meniscus Tear
Osteoarthritis
Osteochondritis Dessicans
Patellar Instability
Patellofemoral Chondromalacia
Posterolateral Corner Injury
Trochlear Dysplasia
20Knee Treatment and Surgeries
Anterior Cruciate Ligament (ACL) Reconstruction
Cartilage Restoration Surgery – Autologous Chondrocyte Implantation (ACI-Carticel)
Cartilage Restoration Surgery – Donor Graft
Collagen Meniscal Implant (CMI)
Lateral Collateral Ligament (LCL) Reconstruction
Medial Collateral Ligament (MCL) Reconstruction
Meniscus Repair
Meniscus Root Repair
Meniscal Transplant
Medial Patellofemoral Ligament (MPFL) Reconstruction
Nanofracture
Osteochondral Allograft Transfer
Osteochondral Autograft Transfer (OATS)
Partial Knee Replacement (MAKO)
Partial Meniscectomy
Posterior Cruciate Ligament (PCL) Reconstruction
Posterolateral Corner (PLC) Surgery
Tibial Tubercle Osteotomy
Total Knee Replacement (MAKO)
Trochleoplasty
20Shoulder Care
10Shoulder-Conditions and Injuries
AC Joint Injuries
Arthritis
Biceps Tendon Injuries
Calcific Tendinitis
Clavicle Fractures
Frozen Shoulder
Labral and SLAP Tears
Rotator Cuff Injuries
Shoulder Dislocation/Instability
Subacromial Impingement/Busitis
10Shoulder-Treatment and Surgeries
A-C Joint Stabilization
Biceps Tenodesis
Clavicle Fracture Fixation
Pectoralis Major Repair
Rotator Cuff Repair
Shoulder Instability Surgery – Bankart Repair
Shoulder Instability Surgery – Latarjet Procedure
Subacromial Decompression and Acromioplasty
Superior Capsular Reconstruction
Total Shoulder Replacement

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.

Post-Operative Rehabilitation

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.


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