A torn medial patellofemoral ligament can cause recurrent kneecap dislocation, knee instability, pain and difficulty returning to normal activities or sports. At OAKS Clinic, Dr. Amyn Rajani provides comprehensive assessment and treatment for MPFL injuries, from conservative management and rehabilitation to MPFL reconstruction surgery.

20+ Years of Orthopaedic Experience | 3,000+ Procedures | Fellowship-Trained Knee Surgeon | AMR Sign

Is Your Kneecap Repeatedly Slipping Out of Place?

A kneecap that slips, shifts or dislocates can make the knee feel unstable even during routine activities. Some patients also experience pain, swelling or apprehension when moving the knee.

You may need an assessment for an MPFL injury if you experience:

• Repeated kneecap dislocation or subluxation
• A feeling that the kneecap may slip out again
• Pain along the inner side of the knee
• Swelling after a dislocation
• Difficulty with sports or sudden changes in direction
• Fear or apprehension when straightening the knee
• Persistent instability after an earlier kneecap injury

These symptoms can occur when the medial patellofemoral ligament is damaged or when underlying knee anatomy increases the risk of recurrent instability.

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What Is an MPFL Tear?

The medial patellofemoral ligament, or MPFL, is a strong band of connective tissue located on the inner side of the knee. It connects the inner side of the femur to the patella and acts as an important passive restraint against the kneecap moving too far towards the outside of the knee.

The MPFL can tear when the patella suddenly moves out of its normal position, particularly during a dislocation. Research has shown that the MPFL provides a significant portion of the medial restraint that helps keep the patella aligned during the early stages of knee flexion.

What Causes an MPFL Tear?

An MPFL tear commonly occurs when the kneecap is forced towards the outer side of the knee.

Common causes include:

• Sudden changes in direction during sports
• Twisting on a planted foot
• Direct impact to the knee
• Falls or awkward landings

Certain anatomical factors can also increase the risk of patellar instability. These include a shallow trochlear groove, a high-riding patella, excessive patellar tilt and an increased TT-TG distance.

Identifying these factors matters because treating the torn ligament alone may not address the underlying cause of repeated instability.

When Should You See a Knee Specialist?

A first-time kneecap dislocation does not automatically mean that surgery is required. The appropriate treatment depends on the injury, knee anatomy, associated damage and risk of recurrence.

A specialist assessment becomes particularly important when you have:

• Recurrent patellar dislocation
• Persistent instability after the first injury
• Significant cartilage damage
• Structural risk factors such as trochlear dysplasia or patella alta
• Repeated symptoms despite conservative treatment
• Difficulty returning to sports or normal activities

A detailed assessment helps determine whether rehabilitation and bracing are appropriate or whether a surgical procedure may provide better stability.

How Is an MPFL Tear Diagnosed?

An accurate diagnosis involves both a clinical examination and appropriate imaging.

Clinical Examination

Dr. Amyn Rajani assesses patellar movement, medial patellofemoral tenderness and knee stability during clinical examination. His assessment also includes the Patellar Apprehension Test, which helps identify kneecap instability.

The AMR Sign

The AMR Sign is an original clinical manoeuvre developed by Dr. Amyn Rajani.

It helps identify the location of MPFL injury during clinical examination and can provide useful information when planning treatment. This is a distinctive aspect of Dr. Rajani's clinical approach to MPFL injuries.

Imaging

Imaging helps determine the extent of the injury and identify anatomical factors that may contribute to instability.

• MRI: Helps identify the location and extent of the MPFL tear, cartilage damage and bone bruising.
• X-ray: Helps assess patellar height, alignment and tilt.
• CT: Can be used to assess the TT-TG distance and other bony anatomy.

These findings help determine whether the MPFL can be managed conservatively or whether reconstruction or an additional procedure should be considered.

Do You Need MPFL Surgery?

Not every MPFL tear requires reconstruction. Treatment is selected based on the patient's symptoms, injury, anatomy, and history of instability.

Conservative Treatment

For selected patients, particularly after a first-time dislocation without significant anatomical risk factors, treatment may include:

• Patella-stabilising brace
• Physiotherapy
• Quadriceps strengthening
• Proprioception and balance exercises
• Ice, compression and elevation during the acute stage
• Gradual return to activity

The knee is then monitored to assess stability and recovery.

When MPFL Reconstruction May Be Recommended

Surgery may be considered when there is:

• Recurrent patellar dislocation
• Chronic MPFL insufficiency
• Significant cartilage damage
• Relevant anatomical risk factors
• Continued instability despite conservative treatment

The aim of reconstruction is to restore medial stability and reduce the likelihood of further patellar dislocation.

MPFL Repair vs MPFL Reconstruction

The choice between repair and reconstruction depends on the type of injury and the patient's clinical and anatomical findings.

	MPFL Repair	MPFL Reconstruction
What is done?	The damaged native ligament is repaired	The damaged ligament is reconstructed using a tendon graft
Common use	Selected acute injuries with suitable tissue	Recurrent instability or chronic MPFL insufficiency
Underlying anatomy	Suitable when major anatomical risk factors are absent	May be considered when recurrent instability or structural risk factors are present
Recovery	Depends on the injury and treatment	Gradual rehabilitation with return to sport based on recovery

Dr. Rajani evaluates the injury and underlying knee anatomy before recommending the appropriate approach.

MPFL Reconstruction at OAKS Clinic

When reconstruction is appropriate, the procedure is planned around the patient's knee anatomy, injury and associated findings.

Dr. Amyn Rajani uses a semitendinosus autograft as the preferred graft choice described in the source material. The procedure is performed with arthroscopic assistance and includes assessment of the knee for associated problems.

Step 1: Assess the Knee

Diagnostic arthroscopy allows the surgeon to assess the cartilage, identify loose bodies and evaluate associated conditions that may affect treatment.

Step 2: Prepare the Graft

The semitendinosus tendon is harvested from the same leg and prepared for reconstruction.

Step 3: Secure the Patellar Side

Secure the graft near the superomedial border of the patella using appropriate fixation.

Step 4: Identify the Femoral Attachment

The anatomical origin of the native MPFL is identified at the medial femoral condyle.

Step 5: Secure the Femoral Side

Position and secure the graft at the appropriate femoral attachment.

Step 6: Check Graft Tension

Tension the graft with the knee positioned appropriately, maintaining correct patellar alignment and avoiding excessive tightening.

The objective is to restore stability while allowing appropriate movement of the patella.

What If There Is an Underlying Knee Problem?

Recurrent patellar instability may sometimes involve more than an isolated MPFL tear.

During assessment, Dr. Rajani may evaluate factors such as:

Trochlear Dysplasia

A shallow or unusually shaped trochlear groove can make it easier for the patella to move out of position.

Patella Alta

A high-riding patella can affect normal patellar tracking and contribute to instability.

Increased TT-TG Distance

A higher TT-TG distance can indicate altered alignment that may contribute to lateral patellar instability.

Cartilage Damage

A dislocation can damage the cartilage or cause loose bodies within the knee.

When required, MPFL reconstruction may be combined with procedures such as tibial tubercle osteotomy, trochleoplasty or arthroscopic cartilage treatment. The decision depends on the patient's anatomy and imaging findings.

MPFL Reconstruction Recovery and Rehabilitation

Recovery after MPFL reconstruction is gradual. The rehabilitation programme protects the reconstruction while progressively restoring movement, strength, and knee control.

Phase 1: Protection

Weeks 0 to 2

The focus is on graft protection, swelling control and early quadriceps activation. A brace and crutches may be used during this stage.

Phase 2: Early Mobility

Weeks 2 to 6

Gradually increase range of motion, patellar mobility, and controlled strengthening.

Phase 3: Strengthening

Weeks 6 to 12

The programme progresses towards full weight bearing, quadriceps and hamstring strengthening, balance training and improved walking mechanics.

Phase 4: Return to Sport

Months 3 to 9

Sport-specific conditioning, jumping and movement drills are introduced progressively when strength and knee stability allow.

Return to competitive sport requires appropriate clinical and functional clearance.

MPFL Reconstruction Pain: What Can You Expect?

Pain and swelling are common during the early recovery period after MPFL reconstruction. You may feel discomfort around the inner side of the knee and at the graft harvest site.

Pain management may include:

• Medication prescribed after surgery
• Local anaesthetic measures during the procedure
• Ice or cryotherapy
• Leg elevation
• Gradual progression of activity

Some patients may also experience temporary nerve-related symptoms around the inner knee. Persistent or severe symptoms should be discussed with the treating surgeon.

Why Choose Dr. Amyn Rajani for MPFL Treatment?

MPFL treatment requires more than repairing a torn ligament. Understanding patellar alignment, knee anatomy, and the reason for recurrent instability is an important part of treatment planning.

20+ Years of Orthopaedic Experience

Dr. Amyn Rajani is a fellowship-trained orthopaedic surgeon with extensive experience in knee reconstruction and joint replacement.

Original Clinical Contribution

Dr. Rajani authored the AMR Sign, a clinical manoeuvre developed to help localise MPFL injury during examination.

Fellowship Training

His international training includes Duke University Medical Center and Prince of Wales Hospital, Hong Kong.

3,000+ Orthopaedic Procedures

His experience includes knee reconstruction, arthroscopy, joint replacement and other complex orthopaedic procedures.

Published Research

His clinical and research work covers MPFL reconstruction, ACL surgery, robotic knee replacement and knee anatomy.

[View Dr. Amyn Rajani's Research and Publications]

Get Your MPFL Injury Assessed

Recurrent kneecap dislocation or persistent patellar instability can affect everyday activities, exercise and sports. A detailed assessment can help identify the cause of instability and determine whether conservative treatment, MPFL reconstruction or an additional procedure is appropriate.

Frequently Asked Questions

What is the success rate of MPFL reconstruction surgery?

Published studies in the source material report recurrence rates of around 5% to 8% after MPFL reconstruction in appropriately selected patients, particularly when relevant anatomical risk factors are also addressed. Individual outcomes can vary depending on the injury and associated knee conditions.

Can MPFL reconstruction be performed with other knee procedures?

Yes. When underlying anatomical or cartilage problems are present, MPFL reconstruction may be combined with procedures such as tibial tubercle osteotomy, trochleoplasty or arthroscopic cartilage treatment. The appropriate combination depends on the patient's anatomy and imaging findings.

Is MPFL reconstruction a day-care procedure?

In selected patients, MPFL reconstruction can be performed as a day-care procedure. The need for an overnight stay may depend on the patient's medical condition, home support and whether additional procedures are performed.

How long does MPFL reconstruction surgery take?

The procedure typically takes around 60 to 90 minutes. Combined procedures may require additional operating time.

Will I need crutches after MPFL reconstruction?

Many patients use crutches during early recovery. A brace may also be used during the initial stages while knee movement and weight bearing are gradually progressed.

How long does MPFL reconstruction recovery take?

Recovery varies depending on the procedure, associated injuries, strength, and rehabilitation progress. Return to sport is generally gradual, with competitive activity considered after appropriate strength and functional milestones have been achieved.

Can an MPFL tear heal without surgery?

Selected first-time injuries can be managed conservatively with bracing, physiotherapy and gradual activity progression. Recurrent instability, significant cartilage damage or relevant anatomical risk factors may require surgical evaluation.

What is the cost of MPFL reconstruction surgery?

The cost depends on the hospital setting, graft and fixation requirements, and whether additional procedures are needed. We can provide a personalised estimate after clinical assessment and treatment planning.