Recurrent dislocation of the kneecap (patella) not only causes pain, but also leads to a feeling of instability, restricted movement, and, over time, permanent cartilage damage in the knee joint. This condition can significantly reduce quality of life and make sports participation almost impossible. If appropriate treatment is not planned in the early stages, each new dislocation can cause further damage to the joint cartilage.
MPFL (medial patellofemoral ligament) reconstruction is the surgical treatment performed in such cases. MPFL surgery is generally not performed alone; it is often combined with tibial tubercle osteotomy.
What Is the MPFL?
The MPFL (Medial Patellofemoral Ligament) is an important ligament that connects the kneecap to the thigh bone (femur). It prevents the patella from sliding sideways. In most cases, the MPFL tears when the kneecap dislocates for the first time. Once torn, the kneecap becomes more prone to recurrent dislocations. In such cases, the ligament needs to be reconstructed.
Causes of Patellar Dislocation
The kneecap moves up and down within a special groove (trochlea) on the thigh bone. However, in some individuals, this groove may be shallow or the kneecap may be abnormally positioned. Additionally, when the MPFL is torn, the patella can drift outward and dislocate.
Common causes of patellar dislocation include:
- Falls or twisting injuries during sports
- Genetic predisposition (loose ligaments)
- High-riding patella (patella alta)
- Trochlear dysplasia (a flat femoral groove)
Symptoms
MPFL tear and patellar instability can cause the following complaints:
- Feeling of the kneecap shifting sideways
- Knee instability or giving way
- Difficulty when going downstairs or playing sports
- Anterior knee pain
- Recurrent kneecap dislocations
Who Is a Candidate for MPFL Reconstruction?
Not every patellar dislocation requires surgery. However, surgical intervention becomes necessary in certain cases. MPFL reconstruction is generally recommended for patients who:
- Have experienced more than one patellar dislocation
- Have an MPFL tear confirmed by MRI
- Cannot achieve stability with physiotherapy and muscle strengthening
- Are young, active, and athletic
Preoperative Evaluation
A correct diagnosis and treatment plan require both clinical examination and imaging studies:
- X-ray: Assesses patella position and possible fractures
- MRI: Shows MPFL tears, cartilage damage, and ligament condition
- CT scan: Evaluates trochlea–patella alignment and measures TT–TG distance
Based on these evaluations, the decision is made whether MPFL reconstruction alone is sufficient or if additional corrective procedures are required.
How Is MPFL Reconstruction Performed?
The MPFL is typically reconstructed using a graft taken from the hamstring tendons (usually the gracilis tendon). Surgical steps include:
- Graft harvesting: Gracilis or semitendinosus tendon is taken.
- Patella tunnels: Small tunnels are drilled on the inner side of the kneecap.
- Patella fixation: The graft is secured to the patella with special screws or suture anchors.
- Femoral fixation: The other end of the graft is fixed to the correct anatomical point on the femur.
- Tension adjustment: The graft is tightened to keep the patella aligned in the midline.
The surgery is not performed entirely arthroscopically, but it is usually done through small incisions, following an anatomical and reliable approach.
Postoperative Recovery
A personalized physiotherapy protocol is essential after surgery:
- Weeks 0–3: Knee brace protection, walking aids as needed
- Weeks 3–6: Gradual increase in range of motion, gentle strengthening
- Weeks 6–12: Strength training, balance, and coordination exercises
- After 3 months: Light jogging and return-to-sport drills
- Months 4–6: Full sports return (based on individual assessment)
Frequently Asked Questions About MPFL Surgery
Will the kneecap dislocate again after MPFL surgery?
With proper surgical technique and rehabilitation, the risk of recurrence is very low.
Is there much pain after surgery?
Pain is generally mild and short-lived, controlled with pain management protocols.
When can sports be resumed?
Depending on the patient and sport type, light return begins around the 3rd month, with full return typically between 4–6 months.
Is MPFL reconstruction alone sufficient?
Each patient is unique. Some cases also require cartilage repair, tibial tubercle realignment, or trochleoplasty.
Conclusion
MPFL reconstruction is a highly successful anatomical surgery for recurrent patellar dislocations. It restores knee stability, especially in young and active individuals, significantly improving quality of life. Early diagnosis, accurate surgical planning, and individualized rehabilitation ensure the best outcomes.
