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Medial Patellofemoral Ligament (MPFL) Reconstruction


What is the medial patellofemoral ligament?

The medial patellofemoral ligament (MPFL) attaches the inside part of the patella (kneecap) to the femur (thigh bone), and plays a vital role in keeping the patella on track by acting like a leash that restrains its movement. Injury to the MPFL may occur during a patellar dislocation from a traumatic injury, as a result of naturally loose ligaments, or due to individual variations in bony anatomy. People with these injuries are often described as having patellar instability.


How do I know if I need MPFL surgery? 

Initially, some patients may benefit from conservative treatment, especially if the patient has experienced a single dislocation without a cartilage injury on MRI. Almost all candidates for MPFL reconstruction have dislocated their kneecap more than once, and in some cases, may have experienced numerous dislocations. Patients who have recurrent instability may need surgery to restore both the medial stabilizing ligaments of the knee and any other associated pathology. MPFL reconstruction offers an excellent treatment option for patients who have recurring patellar dislocations or persistent symptoms despite non-surgical management.


What is an MPFL reconstruction?

MPFL reconstruction is a surgical procedure that involves rebuilding a new ligament to replace the torn and damaged MPFL. During the procedure, Dr. Potts replaces the injured ligament with a portion of a tendon taken either from the patient’s own hamstring (autograft) or from donor tissue (allograft). Reconstruction of the MPFL does involve an arthroscopic portion of the procedure, but another small incision is required to attach the graft to the patella and femur through small bone tunnels and suture anchors. In certain patients, Dr. Potts may also need to perform a tibial tubercle osteotomy (TTO) to correct the bony malalignment, as well.

In rare cases, patients with patellar instability may be candidates for a surgical repair of the MPFL, rather than a complete MPFL reconstruction, such as when the MPFL has pulled a small piece of bone off the inside part of the kneecap.