MPFL (medial patellofemoral ligament) reconstruction is an operation to stabilise the kneecap (patella) in patients with recurrent patellar dislocation. A tendon graft is used to recreate the ligament that prevents the kneecap from sliding outwards.
Incisions are made on the inner side of the knee. A graft (usually a hamstring tendon or synthetic ligament) is passed through a tunnel in the kneecap and secured to the inner side of the thighbone (femur) at the site of the original MPFL. This recreates the restraint that prevents lateral patellar dislocation. The procedure may be combined with other procedures to address bony alignment. The operation takes approximately one to one and a half hours.
Surgery is recommended for patients with recurrent kneecap dislocations that interfere with daily activities or sport, particularly when physiotherapy has not prevented further episodes.
Physiotherapy to strengthen the muscles around the kneecap (particularly the vastus medialis), patellar taping, bracing, and activity modification. These are usually tried first, particularly after a first-time dislocation.
Standard pre-assessment. MRI scan to assess the anatomy. Pre-operative physiotherapy to strengthen the quadriceps is beneficial.
The aim is to prevent further kneecap dislocations and restore confidence in the knee. Success rates are approximately 90% or higher in preventing further dislocations.
Some loss of knee flexion is common initially. Physiotherapy restores this.
Discomfort around the kneecap may persist for some time.
Expected for several weeks.
Approximately 5–10% risk of further dislocation despite surgery.
Excessive tension on the graft can cause medial tracking of the kneecap and pain.
Rare fracture of the kneecap at the graft tunnel site.
Wound or graft infection.
General or spinal anaesthesia with a nerve block for pain relief.
A brace may be worn for four to six weeks, initially limiting the range of knee bending. Crutches for two to four weeks. Physiotherapy is essential and focuses on quadriceps strengthening and gradual restoration of movement. Return to sport at four to six months, guided by physiotherapy milestones.
Wound check at two weeks. Surgeon review at six weeks and three months. Physiotherapy throughout.
The risk is significantly reduced but not eliminated. Approximately 5–10% of patients may experience further instability.
Yes, most patients return to sport at four to six months, including pivoting activities.
In some patients, additional procedures to realign the bony anatomy (such as tibial tubercle osteotomy) may be performed at the same time.