MPFL Reconstruction

Introduction

The Medial Patellofemoral Ligament (MPFL) stabilises the kneecap. It can become ruptured or stretched and, in these cases, can require reconstruction to prevent the knee from dislocating.

Professor Al Muderis has revolutionised MPFL Reconstruction with the introduction of a minimally-invasive technique using LARS (Ligament Augmentation and Reconstruction System) ligaments, that mimic natural knee ligament fibres. This can significantly reduce surgery time, given that there is no longer any need for additional graft harvesting.

Indications and contraindications for MPFL reconstruction

MPFL reconstruction is effective for the treatment of:

Knee instability: where the instability is the result of historic patellar dislocation.

Trauma: including MPFL tear or damage resulting from knee injury.

Structural abnormalities: where patients exhibit a shallow trochlear groove, excessive patellar tilt or misalignment which increases the risk of instability.

Contraindications for MPFL reconstruction include:

Advanced patellofemoral arthritis: where reconstruction is unlikely to alleviate pain or improve function.

Severe malalignment or existing bone issues.

Non-reducible patellar dislocation.

Vascular insufficiency, including avascular necrosis. 

Active infection (local or general).  

Significant ligament damage.

Poor general health, including uncontrolled diabetes, severe heart disease or advanced lung disease. 

Benefits and complications of MPFL reconstruction

Benefits

  • Restoration of patellar stability
  • Pain relief
  • Improved quality of life
  • Reduced risk of recurrent dislocations, enabling prevention of further damage to the knee.
  • Can be performed arthroscopically. 

Known complications

  • Permanent nerve damage resulting in sensory or motor deficits.
  • Superficial or deep infection.
  • Vascular injury and bleeding.
  • Pain. 
  • Deep Vein Thrombosis (DVT).
  • Graft failure. 
  • Joint stiffness.

The surgery

Medial Patellofemoral Ligament (MPFL) reconstruction can be performed using different methods. These include: 

  • Arthroscopic approach: Arthroscopy is a minimally-invasive surgical technique that uses small incisions and a tiny camera (arthroscope) to visualise and perform the procedure. 
  • Open approach: Open surgery requires a larger incision to access the knee joint. It may be used when arthroscopy is inadequate for treatment. 
  • Combined approach: a combination of arthroscopic and open surgery.
 

Preparation prior to surgery

  • You will receive a thorough health assessment: including medical history. You may be advised to modify certain lifestyle factors and you may be referred to another specialist. You may be asked to stop taking certain medications as your surgery date approaches. X-rays, CT scans, and MRIs will be used to evaluate your condition and plan your surgery.  
  • Skin and bowel preparation: On the evening before your surgery, you will be asked to wash your leg using the sponge provided at your pre-admission clinic. A skin test may be administered if an iodine allergy is suspected. You will also be provided medicine to help you evacuate your bowels prior to surgery.
  • Patient education: if neccessary, you may speak with a physiotherapist who can advise you on post-operative mobility. 

 

On the day of the surgery

  • You will be asked to complete your surgical paperwork and will meet with the anaesthetist.
  • The surgical site will be prepared.
  • You will be administered general anaesthesia.
  • A knee arthroscopy is performed to remove loose bodies.
  • Tight structures around the patella are released.
  • A hole is drilled through the patella to accomodate a new ligament.
  • This ligament is secured to the end of the femur, to pull the patella into its right position.
  • The new ligament is tensioned and the patella checked for stability.
  • The wound is then closed in layers, and a bandage dressing is then applied. If no other procedures have been performed, a knee brace is not needed.
 

After your surgery

  • In-patient care: you will remain in hospital for up to three days for monitoring and early-stage rehabilition. 
  • Pain and swelling: You may experience mild to moderate pain. You will be prescribed painkillers to manage these symptoms.
  • Mobilising: You may require a walker or crutches for six to twelve weeks after your surgery.
  • Aftercare: at one week post-surgery, you will be required to attend a wound check and at two weeks your sutures will be removed. At 6 weeks, you will undergo further X-rays to assess healing, and at three months after your surgery for the same reason. You may be prescribed blood thinners to reduce the risk of a clot developing. 
  • Physiotherapy: a tailored program of exercises will be provided to improve motion, mobility and muscle strength around the knee. 

Pre-Surgery Information

Concerns

If you are concerned about your pain level, or develop significant bleeding, fever or redness around the surgical site, please contact us immediately. For after-hours support, contact the hospital at which your surgery was completed. They will contact Prof. Al Muderis on your behalf.

Norwest Private Hospital: (02) 8882 8882

Macquarie University Hospital: (02) 9812 3000

This treatment could be eligible for our
No 'Out-of-Pocket' Expenses Program

For further information, click here or to check your eligibility, please contact our team.