Medial Patellofemoral Ligament Reconstruction
The medial patello-femoral ligament (MPFL) is an important ligament for stabilising the patella (kneecap). Following patella dislocation this structure can be damaged. With appropriate initial management including bracing and physiotherapy this ligament can heal satisfactorily. On occasions however the ligament doesn’t heal well and recurrent instability (dislocation or subluxation) of the patella can occur. In this circumstance surgical reconstruction of the MPFL may be required.
Delayed repair of the ligament is not successful and therefore reconstruction of the ligament with the use of a graft will be necessary.
The initial part of the operation consists of an arthroscopy where a fibreoptic camera is inserted and a thorough examination of the knee and assessment of patella tracking is carried out Once this has been done the hamstring tendon is collected (harvested) for use as a graft. This is collected from a small 3 cm incision on the inner aspect of the tibia (shinbone) of the same leg. Two further incisions are performed to access the patella and the medial (inner) attachment of the MPFL to the femur. Two bone tunnels are created in the patella and the graft passed through these tunnels. A further tunnel is then created in the femur at the attachment of the original MPFL. The graft is passed into this tunnel. The knee is cycled through flexion and extension and the graft is then fixed with an interference screw at the optimum tension to achieve good stability of the patella. The wounds are then closed and dressings and a bandage applied. The procedure is often done as a day case. Crutches may be required for a short period.
Post operative rehabilitation
Appropriate rehabilitation under the supervision of a physiotherapist is essential to ensure a good outcome from this procedure. Good control of post operative pain and swelling should allow early active mobilisation of the the knee along with early full weight bearing. For the first 6 weeks a soft patella brace is worn to protect the reconstruction. During this time exercises to help prevent stiffness and encourage range of motion are undertaken under physiotherapy guidance. These are also aimed at regaining good quadriceps and hamstring function. Further rehabilitation aims to improve strength and agility and may include biofeedback techniques. Most patients should be able to return to active sport between 6 months to 1 year post operatively.