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Medial Patellofemoral Ligament (MPFL) Reconstruction

MPFL Reconstruction Surgeon

The medial patellofemoral ligament (MPFL) is most commonly injured during a high-impact sporting event that includes pivoting or a tackle. The injury occurs when the patella dislocates and tears the ligament on the inside of the knee and surgery may be required to correct it. Knee MPFL reconstruction surgeon, Dr. Nikhil Verma provides diagnosis along both surgical and nonsurgical treatment options for patients in Chicago who have sustained an MPFL tear. Contact Dr. Verma’s team today!

MPFL Reconstruction Overview

The medial patellofemoral ligament, also called the MPFL is similar to a strong rubber band, in that the ligament has elastic-like qualities. The MPFL helps to stabilize the kneecap as the knee moves, and it prevents the kneecap from dislocating to the outside of the knee. The medial patellofemoral ligament is located in the center of the knee, running from the femur (thigh bone) to the middle of the patella (kneecap).
Dr. Nikhil Verma, orthopedic knee surgeon, specializes in MPFL reconstruction and can help patients in Westchester, Oakbrook, Hinsdale and surrounding Chicago communities, recover from an MPFL injury.

How does the medial patellofemoral ligament become injured?

An MPFL tear can be the result of an underlying knee abnormality or a weakened leg muscle. However, the MPFL is most commonly injured during a high-impact sporting event that includes pivoting or a tackle. Athletes who play football, basketball, tennis or soccer are at risk for injuring their medial patellofemoral ligament. During an injury of the MPFL, the patella dislocates and tears the ligament on the inside of the knee. This type of tear almost always occurs when the knee is straight or slightly bent and the kneecap is forced out of place.

What are the symptoms of a torn or injured medial patellofemoral ligament?

Although most MPFL tears are caused by a traumatic dislocation, some tears can occur without an obvious injury. Symptoms of an injured or torn MPFL may include:

  • Pain in the kneecap, especially when palpated or with activity
  • Swelling in the knee after activity
  • Feeling of instability or of the knee “giving way”
  • Stiffness, locking or pain after sitting for a long time
  • Feeling the kneecap slip, especially while turning

How is an injured medial patellofemoral ligament injury diagnosed?

Dr. Verma will inquire about the events that led up to the knee dislocation, or the symptoms experienced. He will obtain a thorough medical history and will test the knee’s range of motion, including where pain is felt. Patients in Chicago will benefit from having an MRI scan, which will allow Dr. Verma to assess the knee and the health of the ligament more thoroughly. An x-ray will only be needed if Dr. Verma suspects bone involvement or a fracture.

What is an MPFL tear?

The medial patellofemoral ligament is the ligament that attaches the femur to approximately the middle of the patella. It is the most important stabilizer of the kneecap and keeps it from slipping to the outside of the knee, causing a lateral patellar subluxation, or dislocation. A tear in the MPFL causes lateral patellar instability and usually occurs after a dislocation.

What are the symptoms of a MPFL tear?

Symptoms of an MPFL tear often include pain in the kneecap with activity and when palpated.  Feeling of instability, or the kneecap slipping when turning or twisting. In rare cases the knee can dislocate when bent.

What is MPFL reconstruction?

Medial patella-femoral ligament (MPFL) reconstruction is a surgical procedure used to correct recurring kneecap dislocation. MPFL reconstruction uses a tissue graft to reconstruct the ligament and hold the kneecap in the correct position on the femur.

How do I prepare for MPFL reconstruction?

Dr. Verma will discuss the reconstruction with you and you will receive a set of pre-operative instructions. Generally, patients can expect to be without food 12 hours prior to their surgery to avoid complications with anesthesia. The surgery will require someone to drive you to and from the hospital. Patients often go home the same day with another set of protocols from Dr. Verma.

How long is does MPFL reconstruction take?

Reconstructive surgery of the MPFL takes approximately 1 hour. The time may vary based on the complexity of the injury and if additional structures need to be repaired or reconstructed.

How long is MPFL reconstruction recovery?

Patients who undergo a MPFL reconstruction must be in a brace for 6 weeks after surgery to allow the ligament to heal. Knee motion is limited to 90 degrees for the first two weeks after surgery and then full motion is allowed. Six weeks after surgery, weight bearing is allowed and patients may wean off the brace as soon as they can ambulate without a limp. The use of a stationary bike is also initiated at 6 weeks after surgery. Advanced exercises to gain endurance and range of motion are initiated at 3 months post-op and most patients are allowed to return to sport and play 5-6 months after surgery.

How to shower after MPFL reconstruction?

Patients are cautioned to keep the wound clean and dry for the first 48 hours after surgery. Beginning on the second day after MPFL reconstruction, it is okay to shower as long as the incisions are kept dry with plastic wrap and you maintain your leg in a straight position. Remove the wrap after showering and replace the dressing and compression stocking.

Is MPFL reconstruction painful?

Dr. Verma will prescribe pain medication to be taken as directed after MPFL reconstruction. Ice and rest with limited activity immediately following the surgery will help to alleviate pain.Generally, patients are able to successfully control their knee pain by following Dr. Verma’s post-surgery protocol.

What tendon holds your kneecap in place?

The patellar tendon holds the kneecap in place. This tendon attaches the bottom of the kneecap to the top of the shinbone. It is actually a ligament that connects to two different bones, the patella and the tibia. The patella is attached to the quadriceps muscles by the quadriceps tendon. Working together, the quadriceps muscles, quadriceps tendon and patellar tendon straighten the knee while keeping the kneecap in place.
The medial patellofemoral ligament (MPFL) is the primary ligament which stabilizes the kneecap and prevents dislocation. When this ligament is torn, recurrent dislocations often occur. Reconstruction of this ligament is required to make the kneecap stable.

What is the difference between MPFL repair vs reconstruction?

MPFL repairs are best utilized when there is a very localized area of a tear at the time of knee dislocation in younger patients. The ligament is repaired, or secured with strong sutures. A MPFL reconstruction uses a tissue graft to completely reconstruct the torn ligament. MPFL reconstruction generally has better surgical outcomes than MPFL repair.

How to manage the pain after MPFL reconstruction?

Patients who have MPFL reconstruction usually receive a nerve  block during surgery. The nerve block takes several hours to wear off after surgery, at which time the patient can control their pain with medication as prescribed by Dr. Verma.

Why does my knee pop or crack after MPFL reconstruction?

Popping or cracking in the knee after MPFL reconstruction is not always a bad sign. After reconstructive knee surgery, the knee is often swollen, and the quadriceps muscles can be weak and scarring also occurs. These factors can affect your knee and can lead to popping and cracking. If the issue does not resolve after physical therapy, you should speak to Dr. Verma.

How soon can I walk or drive after MPFL reconstruction?

Following surgery patients can add weight bearing slowly, as tolerated and crutches may be weaned off gradually. Patients can expect to be allowed to drive (if the surgery was done on the dominate driving knee) in about one month.

Is it normal to have numbness after MPFL reconstruction?

Yes, it is normal to have numbness after MPFL reconstruction. Swelling and bruising are also normal.

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