MPFL Ligament Surgery
MPFL or Medial Patello-Femoral ligament injury due to recurrent dislocations of patella is often identifiable clinically by assessing for the pain, tenderness, swelling and Apprehension sign in which one would be extremely apprehensive when doctor tries to bend the knee slowly while trying to put pressure to push patella (knee cap) to the outside.
X-ray. X-ray is performed and is useful to rule out any bone injuries, however, ligaments are not visible on the X-ray.
MRI Scan. MRI Scan is the gold standard investigation to identify the type and extent of the MPFL injury. In addition, it helps to assess the condition of the meniscus (cushions in the knee joint), cartilage and other ligaments. Often these structures are also affected and need attention.
First Aid for MPFL injuries involves immediate reduction (relocation) of the patella (knee cap) to the place where it belongs to. Further to that R.I.C.E therapy for the first week is invaluable.
Rest. It is important to minimize walking around.
Icepacks. Cold packs 3 to 4 times a day helps reduce the swelling
Compression. Crepe bandage is sufficient to help with compression.
Elevation. Keeping it elevated on a pillow when resting helps.
Post MPFL ligament injury, if other restraints of the knee cap are working and if the Apprehension test is negative, then management would be particularly by improving Quads strength, VMO (Vastus medialis obliqus) muscle strength. Physiotherapists play a major role in this as well as improving patellar tracking to prevent further dislocations of the knee cap.
Surgery is recommended in younger people particularly with recurrrent (repeated) dislocations of the patella. Patellar cartilage loss in addition to MPFL injury warrants the surgery to reconstruct MPFL as well as chondroplasty (regeneration of cartilage). If there are multiple restraints affected, then you may need a bone correcting procedure as well, in addition to the MPFL reconstruction.
MPFL surgery is a day care surgery in which the torn ligament is replaced by your own spare piece of tissue. This is called auto-graft. Graft material can be obtained from cadaver source (another person), however own tissue is preferred and the healing and take up of the material is better. Often it would be hamstring muscles tendon from the inner side of the thigh, where the spare muscle tendons are harvested through small keyholes. The graft is fixed using suture anchors and a bio-composite screw.
Post-surgery, you are allowed to walk on the same day evening using the help of a walker. Within a week most people manage to walk without support. Early mobilistion to get the full range of movement is necessary. Physiotherapy exercises start early. In the first 6 weeks the focus is mainly on getting the full ROM and help regain the muscle strength. The whole rehabilitation process will take about 6 to 8 months before returning back to playing sports on the ground or court.