Do I Need MPFL Reconstruction for Patella Dislocation?
MPFL reconstruction is often recommended when your kneecap keeps dislocating or feels unstable after a patellofemoral injury. If bracing, therapy, or other non-surgical treatments no longer ease your symptoms, surgery may be the right option. To determine if MPFL reconstruction is appropriate, your orthopedic surgeon will assess your dislocation history, exam findings, and response to non-surgical treatments.
Persistent patellar dislocations can limit your mobility and disrupt daily movement. If instability keeps returning, it may signal deeper ligament damage that needs surgical care. At Total Orthopedics & Sports Medicine, our team performs advanced MPFL reconstruction using proven surgical techniques to stop dislocations. We combine precise imaging, expert surgical planning, and guided rehabilitation to help you recover quickly. Schedule your visit today to restore knee function.
When Is MPFL Reconstruction Recommended for Patella Dislocation?
Doctors advise MPFL reconstruction if you have ongoing knee instability, an osteochondral fracture, or failed non-surgical care. These conditions increase your risk of recurrent lateral patellar dislocation. After a first-time dislocation, most doctors recommend a six-month trial of conservative treatment before considering surgery. If knee instability persists during this period, surgical intervention is often the next step.
Moreover, if magnetic resonance imaging (MRI) reveals a torn MPFL and the patella remains unstable, reconstruction is often advised. A damaged MPFL cannot properly secure the kneecap, making repeat dislocations more likely. In such cases, surgical reconstruction helps restore proper patellar alignment and enhances long-term knee stability. Patients with persistent instability frequently choose this option to reduce the risk of future dislocations. According to a Xie et al. study, patients who underwent MPFL reconstruction had an average redislocation rate of 3.7%.
What Causes Lateral Patellar Instability?
Lateral patellar instability often results from a shallow trochlear groove, loose ligaments, or a high-impact injury to the knee. These conditions allow the kneecap to slip out of position during movement. Similarly, injuries from sports or falls can lead to structural damage that increases the chance of dislocation. You may also experience instability if your joints are highly flexible.
According to the National Library of Medicine, people with conditions like Ehlers-Danlos or Marfan syndrome face a higher risk of recurrent patellar instability. Their joints lack normal restraint, which causes the kneecap to shift out of place. In addition, weakness in the vastus medialis oblique reduces muscular support around the patella, making instability worse during movement.
Here are some other structural or congenital factors that can also lead to recurrent lateral patellar instability:
- Congenital dislocations are often seen in patients with Down syndrome
- Habitual dislocations, caused by tightness in the iliotibial band
- Patella alta and trochlear dysplasia, which create poor joint alignment
Who Are the Ideal Candidates for Medial Patella Reconstruction?
The MPFL repair is effective if you’ve had two or more kneecap dislocations because of a weak or damaged MPFL ligament, even after a knee brace. The medial patellofemoral ligament reconstruction surgery also works best when the patient has favorable anatomy, such as patella alta, low TT‑TG. This means the patella dislocates due to ligament damage, and MPFL surgery can effectively fix the problem.
Moreover, patients without severe arthritis are ideal candidates for Patellofemoral ligament MPFL reconstruction. This procedure works best when the knee structures, including cartilage and surrounding ligaments, are still in good condition. If advanced arthritis is present, it may reduce the effectiveness of the surgery and affect recovery. However, a healthy joint surface increases the chance of long-term stability and successful outcomes.
How Is Medial Patellofemoral Ligament Reconstruction Performed?
At Total Orthopedics & Sports Medicine, Dr. Richard McCormack performs this procedure using two small incisions and an arthroscope to ensure precise graft placement. For your comfort, we use regional anesthesia and IV sedation during surgery to keep you relaxed and pain-free.
Once the preparation is complete, we attach the new graft to the patella and femur using an interference screw to secure it in place. To protect growth plates in younger patients, we place the femoral tunnel carefully. Then, we adjust the graft tension to hold your kneecap in place during early knee bending. This entire procedure takes about one hour. You return home the same day with your knee supported in a brace.
Can MPFL Reconstruction Be Combined with Other Procedures?
Yes, surgeons may combine MPFL reconstruction with other procedures to improve long-term knee stability and reduce the risk of redislocation. For example, tibial tubercle osteotomy (TTO) is often recommended when your TT–TG distance exceeds 20 mm. In this procedure, the surgeon repositions the bony bump where the patellar tendon attaches. This reduces the lateral pull on your kneecap and improves its alignment during movement.
According to ScienceDirect, combining TTO with MPFL reconstruction lowers redislocation rates to less than 8% and improves joint function. Additionally, surgeons may perform the following procedures based on your specific knee structure:
- Trochleoplasty: If you have a shallow groove in your thigh bone, called trochlear dysplasia, your surgeon may reshape and deepen the groove. This helps your kneecap stay in place during movement.
- Lateral retinacular lengthening: This procedure reduces tightness on the outer part of your knee, allowing better balance between the soft tissues.
- Combined MPFL and MPTL reconstruction: In patients with generalized ligament laxity or instability in full knee extension, surgeons may reconstruct both the medial patellofemoral ligament (MPFL) and the medial patellotibial ligament (MPTL) to improve overall medial support and reduce recurrence.
Is MPFL Reconstruction Safe for Young Adults?
Yes, MPFL reconstruction is safe and works well for young adults, even if your bones are still growing. During this orthopedic surgery, surgeons place the femoral tunnel carefully to avoid damaging the growth plate. If you’re younger, they may use a quadriceps tendon autograft to avoid stress near growth areas. This approach reduces risk factors and helps you return to normal weight-bearing activities without problems.
According to a Cureus review of 498 young adult patients with at least five years of follow-up, the recurrent dislocations rate after MPFL reconstruction was just 5.75%, and the revision rate was only 0.38%. These clinical outcomes show that the procedure offers long-term success with minimal results of kneecap slipping.
However, poor surgical technique or incorrect tunnel placement can increase the risk of growth plate damage or future instability in young patients. At Total Orthopedics & Sports Medicine, we perform MPFL reconstruction with precise planning, growth-sparing methods, and careful graft selection. Our goal is to deliver safe, stable results that protect your knee. Contact us to restore your knee function.
Are There Any Activity Restrictions After MPFL Reconstruction?
Yes, you will face activity restrictions after MPFL reconstruction to protect the new ligament and support safe healing. Initially, you must wear a knee brace and use crutches for partial weight-bearing during all movement. Your surgeon will limit your knee’s bending and ask you to avoid twisting, squatting, or any side pressure on the kneecap.
As recovery continues, you’ll gradually increase your range of motion and begin light-weight-bearing exercises. Once your knee strength improves, you may also start low-impact cardio. However, high-impact activities like cutting, pivoting, or contact sports remain restricted until balance and strength are fully restored.
Book a Consultation at Total Orthopedics & Sports Medicine For Advanced Diagnosis and Treatment of Patella Dislocation!
If you’re dealing with a traumatic patellar dislocation, your knee may feel unstable and painful. Without proper care, this injury can lead to repeated dislocations, muscle weakness, and early patellofemoral arthritis. Over time, you may also experience constant swelling, loss of strength, and limited knee movement. If your physical examination and radiographic evidence reveal structural damage, you should seek orthopedic care to prevent further joint instability.
At Total Orthopedics & Sports Medicine, we provide orthopedic care for patellar instability using advanced treatments like MPFL reconstruction. Our team carefully reviews your imaging and exam results to plan precise, minimally invasive treatment. From diagnosis to rehabilitation, we focus on restoring joint function, stability, and confidence in your movement. Contact us at 855-321-6784 to schedule your consultation.
FAQs
How Successful Is MPFL Reconstruction at Preventing Redislocation?
MPFL reconstruction is highly successful at preventing recurrent instability, with a redislocation rate of only 1.8% in recent studies. This is much lower than other procedures like MPFL repair or medial reefing. During this surgical procedure, surgeons use strong grafts and precise tunnel placement to restore knee stability. As your quadriceps muscles strengthen and knee flexion improves, your risk of patellar fracture or repeat dislocation remains controlled.
What Are the Risks or Complications of MPFL Reconstruction?
Risks of MPFL reconstruction include patellar fracture, infection, blood clots, knee stiffness, and pain near the medial retinaculum. These issues may affect your recovery after medial patellofemoral ligament surgery. In addition, you may also have limited knee motion if healing is slow or rehabilitation is delayed. To improve surgical outcomes, your doctor may use a nerve block and avoid adding a lateral release unless necessary.
What Are Signs That Non-operative Treatment Has Failed?
Signs that non-operative treatment has failed include lateral patellar subluxation, recurrent patellar dislocation, and ongoing instability in the patellofemoral joint. You may also feel pain or swelling that doesn’t improve with rehabilitation. Moreover, some patients report that their knee feels unstable or slips during regular activity. In this case, minimally invasive surgery near the medial epicondyle may prevent chronic injuries.
When Is MPFL Repair Considered Over Reconstruction?
Surgeons consider MPFL repair over reconstruction when you have an acute patellar dislocation with the ligament torn from the knee joint. This usually happens in new injuries where the ligament hasn’t stretched much. Moreover, you also need a standard knee structure with no patella alta. Early repair helps prevent scar tissue and restores stability when the damage is minor and clearly defined.
What Non‑Surgical Therapies Are Effective for Cartilage Injury?
Non-surgical therapies like rest and knee joint injections can help you recover from cartilage injuries. Additionally, you may also take NSAIDs to reduce swelling and pain. These treatments improve mobility without surgery. If you had a first-time patellar dislocation or MPFL tear, you must protect the tibial tuberosity to prevent further damage. Studies also show a statistically significant difference in outcomes when early care begins.
What Is Lateral Retinacular Lengthening?
Lateral retinacular lengthening is a soft tissue procedure that releases tight tissue on the outer side of your knee. Surgeons perform this to reduce pressure on the kneecap and improve tracking. Moreover, you may need it if your kneecap shifts outward during movement. This procedure often supports other treatments when tightness limits progress or causes pain during rehab.
What Graft Sources Are Commonly Used for MPFL Reconstruction?
Surgeons commonly use autografts or allografts as graft sources during MPFL reconstruction, depending on your knee condition and age. Most procedures use the gracilis tendon as the preferred autograft due to its strength and easy access. However, some surgeons use a semitendinosus-gracilis allograft when donor tissue is needed. Both options provide strong support and help restore knee cap stability during movement and recovery.
