Medial patella-femoral ligament (MPFL) reconstruction is a procedure used to correct serious and recurring dislocation of the kneecap. MPFL is the major ligament, which stabilizes the kneecap and helps in preventing dislocation.

The surgery involves using a ligament take from another part of the body (usually hamstring tendon) to replace the damaged ligament. The MPFL is reconstructed to keep the kneecap in the trochlear groove, preventing dislocation.

MPFL reconstruction is usually very successful. After surgery, patients will need to complete physical therapy/ rehab for 3-6 months to ensure the muscles are strong and stable. Patients can expect to return to unrestricted activities by 6 months to 1 year after surgery.

The main risks associated with this surgery:

– Infection

– Excessive stiffness

– Swelling of the knee

– Bleeding in the knee joint

– Damage to the blood vessels or nerves

– New injury to the knee causing rupture of the ligament graft

– Ongoing instability

MPFL RECONSTRUCTION

Instructions for AFTER the surgery

  • You may put full weight through your leg when walking.
  • Patient must use crutches.
  • Try not to limp.
  • Stop using crutches when able to walk comfortably WITHOUT a limp.
  • All wounds are closed with steri-strips (NO stitches) AND covered with a WATERPROOF dressing.
  • Leave bulky dressing undisturbed for 48 hours.
  • Remove bulky dressing after 48 hours and replace with elastic bandage (Tubigrip) supplied.
  • Wear elastic bandage at all times except for daily shower. (NO soaking, baths or swimming yet)
  • You will need to book the physio, this should start 2-3 days after surgery.
  • Swelling. This is to be expected. Try to rest with the leg fully straight. A pillow under the heel will help with this. DO NOT REST WITH A PILLOW UNDER THE KNEE. Elevate the leg on a pillow or cushion while sitting. An ice pack can be used.
  • Pain. This is worst in the first 48-72 hours after surgery and gradually improves after that. You will receive a prescription for pain medication on discharge. Take the medications as required until the pain is tolerable
  • Possible temporary numbness and/or tingling around the wound site.
  • Excessive persistent pain
  • Pus discharge from wound
  • Fever
  • Excessive pain AND tenderness AND swelling in the calf.

Should any of these symptoms persist, please contact Dr Sim’s rooms or after hours emergency.

MPFL Reconstruction Rehab Protocol

Movement

0-2 WEEKS

Goals

  • Decrease pain and swelling
  • Restore full extension (i.e. getting the knee fully straight)
  • Quadriceps (front of thigh muscle) activation
  • Gait training (i.e. learning to walk properly WITHOUT limping)

Exercises Suggestions

Your first physio appointment should be within 3 days after surgery.

ROM & Flexibility

Remember it is important to restore and maintain range of motion early, especially full extension. This is not harmful to the graft or its stability.

Gait

Use two crutches until you can walk WITHOUT a limp. Then try with one crutch. You can stop using crutches once you walk WITHOUT a limp.

3-6 WEEKS

Goals

  • Achieve near of full ROM in knee flexion and extension
  • Normal gait pattern
  • Quad activation
  • Full knee extension is needed for normal gait

DRIVING

You can consider driving if:

  • You are off strong prescription pain killer (eg Endone)
  • You are OFF your crutches
  • You have GOOD leg control (e.g. you are able to simulate and emergency braking manouvre in a stationary car without any PAIN in the knee)

DO NOT PROGRESS TO STAGE 2 UNTIL ALL GOALS ARE MET

Strengthening

(MUST BE GUIDED/SUPERVISED by Physio)

6-9 WEEKS

Goals

  • Full and pain free knee range of motion
  • Functional quad strength

Exercise suggestions

Hydrotherapy/Pool

  • Knee ROM
  • Walking forward/backward, static lunge, lunge walking squats, side shuffles, step up/down, calf rises (2-1 foot)
  • Hip extension/flexion, adduction/abduction
  • Deep water: stride walking, cycling, flutter kick

Cardiovascular Fitness

  • Stationary bike
  • Swim – Flutter kick only
  • Treadmill – walking

9-12 WEEKS

Goals

  • Continue flexibility/stretching exercises
  • Quadriceps strength progression

Exercise Suggestions

Hydrotherapy/Pool

  • Increase time, speed and repetitions of exercises
  • Pool running

Cardiovascular Fitness

  • Bike – Increased resistance and time parameters
  • Treadmill – Walk +/- incline – quick walk

12-16 WEEKS

Goals

  • Continue with flexibility exercises for the lower chain
  • Continue strengthening (including hamstrings) of all leg muscle
  • Bike – increase time and resistance
  • Treadmill – increase time + incline

Advanced strengthening

4-6 MONTHS

Goals

  • Quadriceps, hamstrings and other leg muscle strengthening.
  • Proprioception training (i.e. learning to sense movement within joints AND the joint’s position)
  • Adequate cardiovascular fitness
  • Running: Progression to running may only occur once a smooth and normal pattern has been attained to prevent abnormal tissue/joint loading in the knee. Running should NOT be initiated if swelling, loss of motion or pain is present.

Exercise Suggestions

  • Continue upper body strengthening

Muscle Strength and Endurance

  • Continue with lower extremity strengthening with specific emphasis on client specific deficits.

Return to Sport

> 6 MONTHS

Goals

  • Return to competitive sport once all goals achieved

AND

  • Physio and Surgeon have declared you fit to do so

Braces

  • These are neither MANDATORY nor NECESSARY whilst playing sport.

MPFL Reconstruction