Medial Patellofemoral Ligament Reconstruction

Introduction

A medial patellofemoral ligament (MPFL) reconstruction is an operation to improve the stability of the kneecap (patella) and reduce pain. Damage to this ligament can cause pain and the kneecap to come out of place (dislocate).

What is the Patellofemoral Ligament?

The medial patellofemoral ligament (MPFL) is one of several ligaments on the inside (medial) aspect of the kneecap. It originates from the inside aspect of the kneecap (patella) and inserts into the outer aspect of the thigh bone (femur) at the knee joint level. It keeps the kneecap (patella) in place, but its main function is to prevent the kneecap moving too far (displacing) to the outside of the knee (Figure 1).

What is a Medial Patellofemoral Ligament Reconstruction?

A medial patellofemoral ligament reconstruction is an operation to strengthen a damaged or stretched medial patellofemoral ligament (MPFL). It is usually performed where there is a history of multiple (recurrent) patella dislocations. A ‘V’ shaped graft (usually taken from part of your hamstring tendons at the back of the knee) is used to reinforce the damaged ligament and attached with surgical fixation ‘anchors’ (Figure 2).

Management Advice Post Surgery 

Rest and elevation 

In the first few weeks it is important to rest and elevate your leg on a stool when you are not walking or doing your exercises. 

Ice packs 

Ice packs can: 1) help relieve the pain and 2) reduce the swelling at your knee. To make your own ice pack wrap crushed ice cubes or a packet of frozen peas in a plastic bag and a tea towel. Apply the ice pack on your knee for 10 to 15 minutes every 2 hours. 

Things to look out for when you are home 

• When the dressings are removed and as the swelling goes down in the leg the brace may need to be tightened up or moved higher up your leg. 
• Your wound is likely to be tender for 2 weeks. Look out for signs of inflammation, redness or leaking. If concerned contact your General Practitioner or visit your local A&E department. 
• A certain amount of pain and swelling should be expected. If you notice numbness, pins and needles or lack of movement in your foot visit your local A& E department immediately. 

Specific instructions 

There will be specific instructions the Consultant Orthopaedic Surgeon will request that you follow after your operation. These will help your recovery and allow the repaired area at the knee to heal: 

• On the day of your operation, once you have recovered from the operation the physiotherapist will fit a hinged knee brace, which you will wear for 6 weeks. 
• The hinged brace should remain on at all times, including washing the leg and performing your exercises. 
• In the shower you can wear a LIMBO cover over the brace. (available for purchase at www.limboproducts.co.uk). 
• The physiotherapist will set the hinges on the knee brace. 

Knee brace 

The hinged brace will be set to restrict the bend at your knee. Do not adjust it yourself (Figure 3).

From Day 0 to 6 weeks the brace is usually set at 0 to 90 degrees bend (although your surgeon may specify a different initial range depending on the requirements of your individual surgery). 

After 6 weeks the brace will be removed by the physiotherapist or your Consultant Orthopaedic Surgeon. 

Elbow crutches 

The physiotherapist will teach you to use crutches. Crutches will allow you to move around following your operation. 

You will be partial weight bearing for 6 weeks. You can put 50% of your weight through your leg. 

You will be taught how to go up and down stairs with crutches, if this is required at home. 

After 6 weeks you will gradually increase the weight through the operated leg until you no longer need the crutches. This can be approximately 10 weeks after your operation. 

Outpatient physiotherapy appointment 

This will be arranged about one week after your operation at a hospital near your home. It is important for you to attend these appointments as the physiotherapist will monitor your progress and give you further advice and exercises. 

Orthopaedic outpatient clinic appointment 

You will attend the outpatient clinic 6 weeks after your surgery where you will be seen by your Consultant. This will be sent to you by post. 

Home exercises 

The following home exercises should be done after your operation. Sit in a well supported and comfortable position on your bed or floor. 

1. Ankle pumps

Pump your feet by pulling your toes and ankles up and down 20 times. Repeat every hour.

2. Range of motion

Bend and straighten your knee a little and often through the day as pain allows.

3. Isometric gluteal exercises

Lying on your back, tighten your buttock muscles.

Hold for 10 seconds.

Repeat 10 times.

Repeat every hour.

4. Patella mobilisations

Sitting with the thigh muscles of your affected leg relaxed move your knee cap from side to side 5 to 10 times.

Repeat every hour.

5. Isometric quadriceps

Without lifting your leg off the bed, tighten your thigh muscles (quadriceps) as if trying to push the back of your knee into the bed. Avoid lifting your leg straight off the bed at this stage.

Repeat 10 times every hour.

If you are able to do Exercise 5 comfortably, progress to No: 6.

6. Straight leg raises

Tighten your thigh muscles as in Exercise 5.

Keeping your leg straight, lift the leg approximately 6 to 10cms off the bed.

Hold for 6 seconds.

Return the leg to the bed slowly.

Repeat 10 times.

Repeat exercise every hour.