Medial Patellofemoral Ligament (MPFL) reconstruction is a surgical procedure that is done to fix the kneecap in people who have a tendency of having their patella dislocate frequently. The MPFL is an important ligament that contributes to the stability of the patella in the femoral groove during movement. This ligament is often torn as a result of injury or repeated dislocation of the knee joint, and reconstruction can aid in the regaining of stability of the knee.

Indications for MPFL Reconstruction

·        Multiple episodes of patellar dislocation or subluxation

·        Persistent patellar instability that has not been managed by non-surgical measures like physiotherapy and knee support.

·        Pathological changes in the knee structure that lead to instability

Preoperative Evaluation

·        Clinical Examination: To evaluate the patellar tracking, ligamentous laxity and overall stability of the knee joint.

·        Imaging: MRI and X-rays to assess the degree of MPFL tear, patella tracking, and possible associated loose bodies, trochlear dysplasia or patella alta.

Surgical Technique

1.     Anesthesia: It is usually done under general or epidural anesthesia.

2.     Graft Selection: A graft is selected to reconstruct the damaged MPFL. Popular options include autografts, which are taken from the patient’s own body, such as the hamstring tendons like the gracilis or semitendinosus, or allografts, which are taken from donors.

3.     Incision and Exposure: An incision is made on the medial aspect of the knee to identify the insertion points of the MPFL.

4.     Graft Preparation: The chosen graft is trimmed to the required length and diameter.

5.     Tunnel Creation: Holes are made in the femur and patella to fix the graft in place.

6.     Graft Placement: It is then passed through the tunnels and is fixed in place by screws or other devices.

7.     Tensioning and Fixation: The graft is then tensioned in a suitable manner for good patellar tracking and then secured.

8.     Closure: The wound is then stitched and the knee is draped with a cloth.

Postoperative Care

·        Immobilization: The knee is usually locked in a brace for several weeks to allow the reconstructed structure to heal.

·        Physical Therapy: Functional rehabilitation starts immediately after surgery and involves range of motion, muscle strengthening, and gradual return to activity.

·        Follow-Up: Continued assessment and evaluation of the healing process and the course of rehabilitation.

Rehabilitation Timeline

·        Weeks 1-4: Emphasis on controlling inflammation and pain, passive mobility, and partial weight-bearing with crutches.

·        Weeks 4-8: Perform range of motion exercises, progress to weight-bearing activities as much as possible, and introduce light muscle strengthening.

·        Months 2-6: Strengthening, stability, and proprioceptive training. Increasing the level of physical activity and exercising more intensively.

·        Months 6-12: Gradually return to sport-specific activities and full participation in sports, as tolerated and cleared by the physician.

Risks and Complications

·        Infection

·        Graft failure or stretching

·        Stiffness or reduced mobility

·        Pain or discomfort at the graft harvest site

·        Recurrent instability

Outcomes

The majority of patients achieve marked subjective and objective improvements in knee stability and function following MPFL reconstruction, with high rates of returning to previous activities and sports. It is quite effective, but the results depend on various factors, such as compliance with the rehabilitation regimen and the presence of other knee issues.

Conclusion

MPFL reconstruction is a proven technique for treating chronic patellar instability and provides a satisfactory treatment option for patients with recurrent patellar dislocations. It is essential to select the right patients, perform the surgery correctly, and manage the postoperative care to ensure the best results.