MPFL reconstruction

An MPFL reconstruction is an abbreviation for a reconstruction of the medial patellofemoral ligament, which is the inner ligament of the kneecap

What is an MPFL reconstruction?

Reconstruction involves replacing the damaged medial patellofemoral ligament (MPFL) because your kneecap has become loose. The MPFL is the ligament that holds the kneecap in place. The new reconstructed ligament is stronger than the one you have naturally. The ligament runs from the inner side of the kneecap/thigh muscle to the inner thigh bone. For the reconstruction of this ligament, a tendon from the hind thigh is most commonly used, which is taken from the inner side of the tibia. However, an artificial ligament can also be used, as can some of the thigh muscle tendon. It is important to emphasize that this is an operation for a loose kneecap and it is NOT an operation for anterior knee pain. If a surgeon offers to operate on you because you have pain around your kneecap and you’re told that the reconstructed ligament will help your kneecap move more properly, know that this is wrong.

MPFL reconstruction

The image illustrates what it looks like. However, the screw on the inner side is not yet screwed in. The screw should hold the new tendon in place until it has grown in after about 3 months.

Lars Blønd

What level of activity is safe after MPFL reconstruction? Normally, I never use a splint and I allow free movement and full weight bearing. A few days after surgery, physiotherapy guided exercises can be started.

If a surgeon offers to operate on you with an MPFL reconstruction because you have pain around your kneecap and you’re told that the reconstructed ligament will help your kneecap move more properly, know that this is wrong and find a more knowledgeable surgeon.

MPFL reconstruction is good surgery

In most cases, this is a very good operation, but there are exceptions. That’s because in some situations, the strain on that ligament will be too great for it to hold up in the long run. Therefore, it is important that you always have at least an MRI scan of the knee before your surgery. This is to check if you have  trochlear dysplasia or Patella Alta or inward pointing kneecaps or another cause of kneecap dislocation. If you have one of these conditions, there is a significant risk that the ligament will not last. Read more here

After surgery?

What are you allowed to do after an MPFL reconstruction? Normally, I don’t use any bandages during these surgeries, which means that you are allowed to fully support your leg and move your knee freely. After just a few days, I recommend starting physiotherapy, including training your thigh muscles and learning to bend your knee. 

Bandage or splint after surgery?

When I started performing MPFL reconstructions in 2005, patients were fitted with Donjoy dressings, but after a few years I realized that the dressings were doing more harm than good. Since then I have not used bandages and never seen any problems as a result and few have performed as many surgeries as I have. In fact, there is now scientific evidence that bandages do more harm than good.

Sick leave after MPFL reconstruction?

How long do you need to be on sick leave from school or work? That’s a great question as some people are back at work after just 1 week, but it’s all about what you work with and how you transport yourself back and forth and there is a lot of individual variation. If you have a physically demanding job, expect it to take a few months or more.

Sport

Where can you resume sports? Of course, it depends on the sport you play, but contact sports should only be resumed after 4 months and when your musculature and balance have recovered. The latter often takes more than 4 months.

Problems after MPFL reconstruction

Unfortunately, I see a lot of patients where the ligament has torn again or where there is now anterior knee pain.  There are a variety of reasons why some people continue to have problems. For examplle this can be caused is placed incorrectly or if you are havingtrochlear dysplasi or a torsion of your thighbone, for exsample an increased femoral anteversion – which means that your thighbone is rotated too much inwards and you have inward-pointing kneecap.