Medial patellofemoral ligament (MPFL) reconstruction

Medial patellofemoral ligament reconstruction
File:MPFL Reconstruction.png Diagram showing the medial patellofemoral ligament (MPFL) reconstruction procedure
Details
System	Musculoskeletal system
Location	Knee joint
Function	Stabilization of the patella (kneecap)
Identifiers
TA98
TH	{{#property:P1694}}
TE	{{#property:P1693}}
FMA	{{#property:P1402}}
Anatomical terminology

Medial patellofemoral ligament (MPFL) reconstruction is a surgical procedure performed to restore stability to the patella (kneecap) in cases of recurrent patellar dislocation or chronic patellar instability. The procedure involves the reconstruction of the MPFL, a ligament located on the medial (inner) side of the knee joint that helps to keep the patella in its proper position.

Anatomy

The MPFL is a strong band of tissue that originates from the medial femoral condyle (the bony prominence on the inner side of the thigh bone) and attaches to the inner edge of the patella. Its primary function is to prevent lateral (sideways) displacement of the patella during knee movements. The MPFL works in conjunction with other structures, such as the quadriceps muscles and the medial retinaculum, to provide stability to the patella.

Indications

MPFL reconstruction is typically indicated in cases of recurrent patellar dislocation or chronic patellar instability that does not respond to conservative treatment methods. Recurrent patellar dislocation refers to the repeated episodes of the patella slipping out of its normal position, often resulting in pain, swelling, and functional limitations. Chronic patellar instability refers to a condition where the patella is consistently unstable, leading to frequent subluxation (partial dislocation) or dislocation.

Procedure

The MPFL reconstruction procedure is usually performed under general anesthesia. The surgeon makes a small incision on the inner side of the knee to access the MPFL. The torn or stretched MPFL is then identified and removed.

Next, a graft is harvested from a nearby tendon, such as the hamstring tendon or the quadriceps tendon. The graft is prepared and then passed through tunnels drilled in the femur and the patella. The graft is then secured to the bone using various fixation methods, such as screws, anchors, or sutures.

After the graft is secured, the knee is tested for stability and range of motion. The incision is closed, and a sterile dressing is applied. The patient is usually advised to use crutches and wear a knee brace for a period of time to protect the reconstructed MPFL during the initial healing phase.

Rehabilitation

Following MPFL reconstruction, a comprehensive rehabilitation program is essential for optimal recovery and long-term success. The rehabilitation program typically includes a combination of physical therapy exercises, such as range of motion exercises, strengthening exercises, and proprioceptive training. The goal of rehabilitation is to gradually restore strength, stability, and function to the knee joint.

Complications

As with any surgical procedure, there are potential risks and complications associated with MPFL reconstruction. These may include infection, bleeding, blood clots, nerve or blood vessel injury, stiffness, and failure of the graft. It is important for patients to discuss these risks with their surgeon and follow all post-operative instructions to minimize the chances of complications.