Medial Patellofemoral Ligament Repair (MPFL) Reconstruction for Patella Dislocation

MPFL tear results in

• Pain in the knee joint on the inner aspect of the Patella/kneecap
• Swelling of the knee joint
• Instability of Patella
• Recurrent dislocation of Patella

Investigations done are mainly X-rays of the knee joint in different views and MRIs of the knee joint.

Most cases of Patellar dislocation due to MPFL tear are treated without surgery with Rest

• Knee brace
•  Ice packing
•  Protected weight bearing
•  Pain killers

But these are for cases where dislocation has occurred for 1 st time.

Yes, in most cases who present at 1 st dislocation can heal on their own. But chances of healing after further dislocations decrease.

Yes, after 1 st dislocation, healing of the ligament occurs, but there are chances of the ligament remaining loose, so chances of re-dislocation increase.

If surgery is not done, then

• Chances of early onset osteoarthritis are present
• Instability of knee joint which may not allow the patient to perform routine activities
• Chronic pain in the knee joint

• Recurrent or multiple dislocations of the Patella is the most common cause of MPFL reconstruction.
• Failed non-surgical treatment of Patella.

MPFL reconstruction surgery is most commonly done in MPFL tears. It involves the use of a graft that is fixed to the Patella and femur. The graft is fixed in position, which mimics the original graft function. The graft is set to the position with the help of screws and buttons.

It usually takes 1-2 hours for MPFL reconstruction.

Yes, the patient can walk with torn MPFL, but he will not have confidence in running, climbing or going downstairs due to the instability of the Patella.

Fixation devices most commonly used are buttons and screws in MPFL reconstruction surgery.

• Button with threads attached to them used in ACL reconstruction surgery fixes graft to femur and tibia. These can be from different companies and are used depending on surgeons' preferences.
• Most commonly used to attach the graft to the femur/ thigh bone.

• Screws used in MPFL reconstruction surgery can be bioabsorbable or hydroxyapatite coated.
• Bioabsorbable screws dissolve inside the bone. These screws are usually absorbed within 2 years and don't cause inflammation, clinical problems, or reactions. But further studies are required to know about detailed properties.
• Hydroxyapatite-coated screws.

• Hydroxyapatite is naturally present in the bone and teeth of humans up to 50% volume and 70% weight.
• Screws coated with hydroxyapatite have a natural tendency to fix the bone.
• They also help in increased bone formation and better healing.
• Reduces infection risk
• Less chances of allergies or other sensitivities
• They are better for X-ray and other imaging as they are radiopaque hence better visibility.
• The ultimate decision of choosing between types of screws should be taken in consultation with the surgeon.

This is one of the new techniques which is in use. This technique involves MPFL  repair instead of MPFL  reconstruction, no graft is taken, and the original MPFL  is repaired. Fibre tape is used to provide strength to repaired MPFL. Although it provides better functional outcomes, few studies are present to support the current concept. Many studies have concluded no difference between MPFL reconstruction and MPFL repair with the internal brace technique. Detailed studies are further required to provide depth knowledge.

Yes, with newer techniques, MPFL reconstruction can be completed in teenagers with a high success rate.

Patients can walk within the very next day of MPFL reconstruction. But braces have to be used to keep the knee straight.

You can shower within 2-3 days after ACL reconstruction surgery. Usually, waterproof dressing is applied to the wound, after which the patient can shower. But to take a bath or swim a patient will require 4-6 weeks. The patient has to keep the wound dry and avoid using hot water as it increases swelling.

Usually, it depends on the patient's medical condition; if the patient is not suffering from any disease before surgery, hospital stay is for 1-2 days.

After six weeks in the brace, gradual knee joint mobilisation is done under the proper guidance of the surgeon and physiotherapist.

Usually, it takes 4-6 months for a patient to return to sports after MPFL reconstruction. But it depends on the severity of the injury and rehabilitation results.

Usually, the patient will be able to join the office in 4- 6 weeks, depending on the recovery status of a person. Patients with heavy-duty/a lot of physical work in the office must wait 3-4 months.

Yes, the patient will be able to perform activities that he used to do before MPFL reconstruction.

It depends on the hospital category chosen by patients and the type of implant discussed. At Simpainortho.com, we have tried to reduce the cost of surgery and hospital expenses and included complete after-surgery services, which patients require after surgery because we know treatment doesn't end at the patient's discharge. To ensure the quick recovery of patients in impainortho.com, we believe that a patient requires expert care within the most comfortable surroundings until he can join routine activities. So, we have made different packages for different patients according to need, and that too at the most affordable prices.

Yes, most insurances have included MPFL reconstruction surgery.