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MPFL Reconstruction: Restoring Patellar Stability

MPFL reconstruction is a surgical procedure to restore the medial patellofemoral ligament of the knee, treating recurrent patellar dislocations and chronic kneecap instability.

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MPFL reconstruction is a surgical procedure to restore the medial patellofemoral ligament of the knee, treating recurrent patellar dislocations and chronic kneecap instability.

What is MPFL Reconstruction?

MPFL reconstruction (medial patellofemoral ligament reconstruction) is a surgical procedure in which the medial patellofemoral ligament – a key stabilizing structure on the inner side of the knee – is rebuilt or restored. This ligament connects the kneecap (patella) to the inner side of the thigh bone (femur) and prevents the kneecap from dislocating outward (laterally). When this ligament is torn or stretched due to injury or repeated dislocations, it can no longer perform its stabilizing function.

Indications: When is MPFL Reconstruction Recommended?

The procedure is primarily recommended for patients suffering from recurrent patellar dislocation – repeated episodes in which the kneecap slips out of its groove. Typical indications include:

Two or more patellar dislocations
Chronic patellar instability despite conservative treatment
First-time dislocation in young, active patients with high-risk anatomy
MRI-confirmed MPFL rupture
Significant limitation of daily activities and quality of life

Anatomical Background

The medial patellofemoral ligament (MPFL) is a thin but functionally critical structure on the medial (inner) side of the knee joint. It runs from the medial border of the patella to the medial epicondyle of the femur. Biomechanical studies have shown that the MPFL provides approximately 60% of the medial restraint against lateral patellar displacement. In virtually every lateral patellar dislocation, this ligament is torn.

Surgical Technique

MPFL reconstruction is typically performed under general or spinal anesthesia and takes approximately 45 to 90 minutes. While the specific technique varies by surgeon, the general steps are as follows:

Graft harvesting: The most commonly used graft is the gracilis tendon (a tendon from the inner thigh) or the semitendinosus tendon. Donor (allograft) tendons may also be used.
Knee arthroscopy: A diagnostic arthroscopy is often performed simultaneously to identify and treat associated injuries such as cartilage damage.
Tunnel creation and fixation: The graft is secured at the patella and femur using bone tunnels, typically fixed with interference screws or suture anchors.
Tension control: The tension of the reconstructed ligament is carefully checked intraoperatively to prevent over-tightening, which could restrict knee movement.

Postoperative Care and Rehabilitation

Rehabilitation is essential for a successful outcome. It is generally divided into the following phases:

Phase 1: Early Phase (0–6 Weeks)

Partial weight-bearing with crutches, continuous passive motion (CPM) device, lymphatic drainage, cryotherapy (ice therapy) for swelling reduction, and isometric exercises to activate the quadriceps muscle.

Phase 2: Strengthening Phase (6–12 Weeks)

Full weight-bearing, progressive strength and coordination training, stationary cycling, and targeted physiotherapy focusing on the vastus medialis obliquus (VMO) muscle, which actively stabilizes the kneecap.

Phase 3: Sport-Specific Rehabilitation (From Approx. 3 Months)

Running training, sport-specific exercises, and proprioceptive training. Return to competitive sports is typically possible after 6–9 months.

Outcomes and Prognosis

MPFL reconstruction yields excellent results in the medical literature. Studies report success rates exceeding 90% in preventing recurrent dislocations. The majority of patients return to full sporting activity. Good outcomes depend on appropriate patient selection, technically precise surgery, and consistent rehabilitation.

Possible Risks and Complications

As with any surgical procedure, MPFL reconstruction carries certain risks:

Wound infection
Deep vein thrombosis or pulmonary embolism
Stiffness (arthrofibrosis)
Persistent pain
Graft malposition leading to recurrent instability
Nerve or vascular injury
Patellar fracture (rare) during tunnel drilling

The overall risk of serious complications is low when the procedure is performed by an experienced surgeon.

MPFL Reconstruction Compared to Other Procedures

Other surgical options for patellar instability include MPFL plication (tightening the existing ligament in partial tears), trochleoplasty for trochlear dysplasia, and tibial tubercle osteotomy (TTO) for an elevated TT-TG (tibial tubercle to trochlear groove) distance. These procedures are often combined with MPFL reconstruction when multiple anatomical risk factors are present.

References

Petri M, et al. – MPFL reconstruction for recurrent patellar instability: clinical outcomes and return to sport. Knee Surgery, Sports Traumatology, Arthroscopy, 2022.
Lenschow S, Herbort M – Patellar stabilization: MPFL reconstruction. In: Knee Surgery, Thieme Publishing, 2020.
Dejour D, Saggin P – The sulcus deepening trochleoplasty – the Lyon's procedure. International Orthopaedics, 2010; 34(2): 311–316.

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