MPFL Tear & MPFL Reconstruction
The Medial Patellofemoral ligament, a distinct condensation of capsular fibers which originates at the medial epicondyle of femur (thigh bone) and runs horizontally to insert on the superomedial aspect of Patella (Kneecap).
The Function of MPFL is to help in resisting lateral (outward) migration of patella (knee cap) and thus prevent dislocation of patella. The MPFL is most effective between 0 and 30 degree of flexion.
Tear of MPFL :
The MPFL may tear due to an acute lateral dislocation of Patella. The femoral attachment is the one which gets torn frequently. The torn MPFL may then act as a precursor to recurrent dislocation of the patella.
Pain over the medial aspect.
Tenderness over medial aspect.
Clinical Tests :
Patella Apprehension Test is positive.
Pushing the patella out laterally may cause apprehension to the patient forcing him to bend his knee.
This is usually based on history of recurrent dislocation, presence of a positive apprehension test. X-Ray (merchants view) of the knee may show Patella sublaxated.
MRI is done to confirm diagnosis and also see for other bony abnormalities which can give rise to recurrent dislocation.
Conservative Management :
If there is only one episode of dislocation, conservative management is the treatment of choice. This includes 3 weeks of immobilization in long knee brace after acute episode of dislocation.
Ice fomentation and anti-inflammatory medications.
This is followed by extensive rehabilitation.
Surgical Management :
This is usually indicated in chronic MPFL Tears which cause recurrent dislocations.
The MPFL Reconstruction is done using the semitendinosis tendon autograft.
The new MPFL Graft is attached to the patella with 2 small plastic anchors. The femoral side of the graft is attached with an absorbable screw. The graft will grow into the bone in 3-4 months, however full recovery for return to sport can take anywhere from 4-24 months.
Most patients will stay in hospital for 1 night after surgery although you have the option of going home on the same day if your pain is well-controlled.
Surgical Steps :