Medial Patellofemoral Ligament (MPFL) Reconstruction Surgery

MPFL Reconstruction is a surgical procedure that corrects recurring kneecap dislocation. It involves forming a new ligament to stabilise the knee and prevent further damage. This surgery is effective for those who've had several dislocations, and it's usually performed at an outpatient facility by an orthopaedic knee surgeon. 

Football, basketball, tennis, and soccer players are at significant risk of injuring their medial patellofemoral ligament. The surgery typically takes one hour, is minimally invasive, and has a shorter recovery time than traditional knee surgery. After surgery, the knee is immobilised for six weeks, followed by a physical rehabilitation program. Most patients resume regular activities within four to six months. For a speedy recovery, it's crucial to follow the rehab protocol strictly.

Understanding The Kneecap and How it is Repaired

1. Patella: The patella, also known as the kneecap, is a small, rounded mobile bone on the front of the knee.
2. Function of the Patella: The function of the patella is to move in a vertical direction as the knee bends and straightens.
3. Medial Patellofemoral Ligament (MPFL): The patella is connected to a network of soft tissues stabilising the knee. The inner part of this network is known as the medial patellofemoral ligament (MPFL). The MPFL stabilises the kneecap and prevents it from dislocating outwards.
4. MPFL Reconstruction: A tear in the MPFL can result in knee abnormality or dislocation. After an MPFL injury, the patella dislocates and rips the ligament inside the knee. This rip happens when the knee is straight or slightly flexed, and the kneecap is pushed out of place. So, to stabilise the knee cap, MPFL reconstruction is required to repair or reconstruct the torn ligament.

Who is a Candidate for MPFL Reconstruction?

Patients with lateral patellar instability (kneecap dislocation) are generally considered good candidates for MPFL reconstruction. However, not all patellar dislocations need MPFL surgery. Some conditions can be treated with immobilisation followed by physiotherapy. 

Patients who suffer from front knee pain or kneecap arthritis are also considered good candidates for this minimally invasive surgery. 

Apart from this, the following reasons make a good candidate for medial patellofemoral ligament reconstruction:

• Sharp pain in the kneecap
• Ligamentous laxity
• Muscular weakness
• Multiple dislocations of the kneecap
• Stiffness, locking, or pain in the kneecap

Who should not Consider MPFL Reconstruction?

The following factors affect the eligibility for MPFL surgery:

• High-grade trochlear dysplasia
• Severe PF osteochondral damage
• Skeletal immaturity
• Weak immune system
• Heart condition
• History of medical conditions
• Smoking
• Bleeding disorders, anaemia, or any other chronic illness
• Unable to tolerate anaesthesia

How to Prepare for MPFL Reconstruction Surgery?

The first and foremost step to take while preparing for the surgery is knowing the complete details. Ask the surgeon about MPFL reconstruction surgery in detail, including the benefits of having the surgery and the potential risk factors.

Once done, the doctor may perform a physical examination to check for visual instability in the kneecap. Other tests may include MRI, CT scan, blood tests, X-ray, and more to get a detailed overview. The doctor will also ask about allergies or a family history of bleeding disorders.

Other preparations for MPFL reconstruction surgery may require the following:

• Maintaining a healthy diet.
• Quitting smoking (it delays the healing process and increases the risk of postoperative complications)
• Avoiding anti-inflammatory medications
• Stopping blood-thinning medications for two weeks before the surgery
• No eating or drinking for a few hours before the surgery
• Pre-arranging a ride home after the surgery

MPFL Reconstruction Procedure

The MPFL reconstruction surgery generally takes around one hour. It is an outpatient procedure, meaning patients can go home on the same day of the surgery. The procedure is as follows:

• Anaesthesia: The patient is administered general anaesthesia or regional anaesthesia (like spinal or epidural anaesthesia).
• Incision: The surgeon makes a small incision on the inside of the knee to access the patella and the femur.
• Graft preparation: The surgeon harvests a graft from the patient's hamstring, quadriceps, or patellar tendon. The graft is a strip of tendon tissue long enough to span the distance between the patella and the femur.
• Graft fixation: The graft is threaded through tunnels drilled into the patella and the femur. The graft is then anchored to the bone using screws, sutures, or other fixation devices.
• Closure: A sterile dressing is put on the wound after the incision is stitched or stapled shut.
• Recovery: The patient may get painkillers and antibiotics to avoid infection while being watched in the recovery room for a few hours. Additionally, the patient will be given postoperative care instructions, which include how to take care of the incision site, when to start physical therapy, and what activities to avoid while recovering.

Complications of MPFL Reconstruction

MPFL reconstruction, like any other major surgery, carries risks, including bleeding, infection, and anaesthetic reaction. Other potential issues include:

• Infection
• Excessive stiffness
• Blood clots
• Swelling around incision
• Swelling of the knee
• Bleeding in the knee joint
• Damage to the blood vessels or nerves
• New injury to the knee causing rupture of the ligament graft
• Ongoing instability

Taking Care of Yourself After Surgery

MPFL reconstruction has a high rate of success. Patients may require physical therapy/rehab for 3-6 months following surgery to ensure the muscles are strong and stable. Patients can also expect to resume normal activities six months to a year following surgery.

Patients need to follow some rehab protocols after the reconstruction surgery. The doctor will advise walking during the initial stages and will put in a knee brace for a few weeks. 

The physician will then help with knee range of motion exercises and sessions of physiotherapy to ensure a speedy recovery. Apart from this, the doctor may advise:

• Avoiding physical activities like vigorous exercising and lifting heavy weights for four to six weeks
• Avoiding operating heavy machinery like driving a car for a few weeks
• Keeping the incision area clean and covered with a dressing
• Maintaining a healthy lifestyle
• Following up with the doctor regularly

One should call a doctor if the following symptoms appear:

• Fever
• Excessive drainage from the incision,
• Severe heat and/or redness along the incision,
• Uncontrolled pain
• Excessive swelling in the calf

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