What is the Medial Patellofemoral Ligament?
The medial patellofemoral ligament (MPFL) helps to stabilise the patella (knee cap). The ligament attaches to the upper third of the patella and the inner aspect of the femur (thigh bone). It functions as a tether to stop sideways movement and dislocation of the patella.
MPFL tears happen when the patella is dislocated either traumatically e.g. following a tackle during sport, or atraumatically due to instability because of ligament laxity or reduced thigh muscle strength and control.
Some people can function satisfactorily without an MPFL by working on a programme of intensive rehabilitation. If symptoms of patella instability persist, a reconstruction of the ruptured ligament is often necessary.
You and your surgeon have decided that an MPFL reconstruction is the best way to manage your injury. The expected outcome of surgery is:
- Improved knee stability
- Improved function/mobility
- Reduced pain
- Recovery of function and return to previous level of
The operation involves using part of your hamstring/gracilis tendons (from the inner aspect of your knee) to replace the torn MPFL inside your knee joint.
During the reconstruction a small incision (cut) is made over the upper and inner part of your shin to harvest (remove) the tendon which is to be used for your graft. A further incision is made along the inside border of your patella so that two tunnels can be drilled into the patella.
The free ends of the graft are then placed into the tunnels and fixed in place. A third incision is made at the inner aspect of your knee so that a tunnel can be drilled into your femur. The loop of the graft is passed into this tunnel and fixed into place with a screw. The position of the graft closely matches the original position of your ruptured MPFL.
You will also have two very small incisions – one on either side, just below your patella. This is so that the arthroscope (keyhole camera) can be used to check the whole of your knee joint for any further damage.
The wounds are usually closed with stitches and/or steri-strips, covered with dressings and bandaged with a wool and crepe bandage to keep the swelling to a minimum for the first 24 to 48 hours. Dependent on your muscle control, you may also have a knee splint in situ for 48 hours after surgery to help stabilise the joint and protect the graft until your muscle function returns.
All operations involve an element of risk:
- Potential problems for MPFL reconstruction include graft rupture, joint stiffness, and aching.
- Uncommon problems include infection and blood clot (DVT).
- Rare problems include nerve or blood vessel
- Minor complications relating to the anaesthetic such as sickness and nausea are relatively common. Heart, lung or neurological problems are much
Please discuss these issues with the doctor if you would like further information.
Frequently Asked Questions
This is used to decrease the pain in the knee joint and the incision area immediately after your operation which can:
- Reduce the risk of feeling sick or vomiting
- Allow you to eat and drink earlier
- Enable you to get up and mobilise earlier
- Lessen the chance of an overnight stay in hospital
You will be given painkillers (either as tablets or injections) to help reduce the discomfort whilst you are in hospital. A one week prescription for continued pain medication will be given to you for your discharge home. Keep the pain under control by using the medication regularly at first. It is important to keep the pain to a minimum as this will enable you to move the knee more easily, recover muscle function in your thigh muscles, and begin the exercises you will be given by the physiotherapist.
f you do not have any circulatory disorders, you will benefit from applying ice regularly following surgery. This will help to minimise pain and swelling. Firstly wrap the knee with cling film when applying prior to your wound having healed. Then place a bag of frozen peas, ice cubes, or an ice pack in a damp tea towel. Elevate your affected leg and apply your ice pack for approximately 20 minutes. This should be done regularly throughout the day.
You will be provided with a pair of crutches for use when walking. Unless you have been instructed otherwise, due to more complex surgery (such as a cartilage repair in addition to your ACL repair) the crutches are used for comfort. You can gradually decrease their use as comfort allows. It is important that you take the weight through your leg in the correct manner i.e. putting the heel down first. Be guided by your physiotherapist who will inform you as to when you can discard them. The crutches can be returned to Wrightington physiotherapy department when you have finished using them. It is very important you follow the advice on how to use the crutches and avoid twisting or pivoting on your knee as this may damage your graft. It is also important that you are not on your feet for prolonged periods of time early on after the operation as this may increase your swelling.
Yes. It is important to start getting the knee moving but in a controlled manner. The Physiotherapist will show you the exercises you will need to start with. These will be progressed as you are physically able under the guidance of your physiotherapist. You will be referred for continued physiotherapy as an out-patient and it is essential that you are seen within one week of your operation.
When you are discharged from hospital you will have a compression bandage on your knee that should remain in place for 24-48 hours. After this time, remove the bandage and change the small plaster dressings underneath if they are blood stained. You must take extra care to ensure you have thoroughly washed your hands to prevent infection before you change the dressings.
It is important to keep your wound clean and dry until it is fully healed. Stitches, clips or steri-strips may need removing which is usually carried out between 10 and 14 days after your operation. The ward staff will inform you about how to get them removed. They may send a referral to your GP or you may be instructed to go to your GP to arrange this yourself. Alternatively, this may be done at your first clinic visit. The wound should remain covered with the dressings until the stitches, clips or steri-strips are removed.
You may shower before the removal of the stitches/clips/steri-strips – you will need to put several layers of cling film around your knee to keep the area dry. Pat the area when drying yourself and do not rub over the wound sites. Be guided by the clinician who
removes your stitches/clips/steri-strips as to when you can stop using cling film and leave the wound uncovered.
An appointment is usually arranged for 2-3 weeks after you are discharged from hospital to check your progress. Please discuss any queries or worries you may have when you are at the clinic. Appointments are made after this as necessary.
If you have not received an appointment it is essential you phone the outpatient department.
Your physiotherapy appointments should begin within one week of your operation and these will continue for several months until you are able to return to your normal pre-injury activities.
To protect your new graft you will need to avoid putting too much stress through it. You should not perform any twisting, turning or pivoting manoeuvres on your affected leg. You should also avoid straightening the leg out when you are in a sitting position i.e. a leg extension exercise.
You should avoid standing for prolonged periods of time as this will increase the swelling in your knee. If your knee is swollen you will need to elevate your leg and use ice as instructed.
It is important to avoid walking with a limp – use crutches if needed to allow you to put the weight through your leg in the correct manner i.e. walking with the heel going down first, and also not walking on a bent knee.
This can be divided into 3 stages.
- Sling on, no movement of shoulder except for exercises
You will basically be one handed immediately after the operation. This will affect your ability to do everyday activities, especially if your dominant hand is the side of the operation.
Activities that are affected include dressing, shopping, eating, preparing meals and looking after small children. You will probably need someone else to help you. You may also find it easier to wear loose shirts and tops with front openings.
- Regaining everyday movements
When advised, you can gradually wean off using the sling and you will start outpatient physiotherapy. You will be encouraged to use your arm in front of you, but do not take it out to the side and twist it backwards. Exercises will help you regain muscle strength and control in your shoulder as the movement returns. The arm can now be used for daily activities.
Gradually, you can return to light tasks with your arm away from your body. It may take 6-8 weeks after your operation before you can use your arm above your shoulder height.
- Regaining strength with movement
Under guidance, you will be able to increase your activities, using your arm away from your body and for heavier tasks. You can start doing more vigorous activities, but contact sports are restricted for at least 4-6 months. This is dependent on the procedure and should be discussed with your surgical team. You should regain the movement and strength in your shoulder within 6-8 months. Research has shown that after 2-5 years about 90 out of 100 people have a stable shoulder with few limitations. Vigorous sports or those involving overhead throwing may require adaptation for some people, although many return to their previous levels of activity.
You may drive when you are comfortable and safe to do so. You must have stopped using crutches, be able to sit comfortably and have enough power and bend in your knee to perform an emergency stop. The law states that you should be in complete control of your car at all times. It is your responsibility to ensure this and to inform your insurance company about your surgery. Please ask your physiotherapist for advice.
When you return to work depends very much on the demands of your job and it is difficult to generalise. You need to feel that you can cope with the tasks involved in performing all duties of your job including any travelling required. As a general rule it is recommended that if you are in a sedentary job you will require approximately 2-3 weeks off work. For a heavy manual job or one which involves twisting, turning and running you may require up to 12-16 weeks. Discuss this with your surgeon and physiotherapist before you contemplate a return to work and you may also wish to consider approaching your employer regarding a phased return.
It is recommended that you do not fly for six weeks after the surgery.
During your first visit after surgery your physiotherapist will decide how often they would like to see you depending on your progress. Initially you may need regular appointments to help and support you through the early stages of rehabilitation. You will be given exercises to perform at home and in the gym and you may progress to a gym-based class at the physiotherapy department.
It is extremely important that you continue to work on the exercise programme you are given and follow your physiotherapist’s instructions carefully.
Your return to leisure activities will be guided by your physiotherapist and will depend on how you are progressing and whether you are reaching certain goals. Your therapist will advise you when you are physically capable of dealing with different activities and will ensure you progress to a level where it is safe for you to return to sport.
The earliest return to sport is 6 months after your operation but this will vary depending on your progress. It is extremely important that you take guidance on this by your physiotherapist, as if you return too early you may not achieve a good outcome from your surgery, and you have a greater chance of your reconstruction failing.