Medial patello-femoral ligament reconstruction



Patient Information

Orthopaedics

Medial Patellofemoral Ligament (MPFL) Reconstruction

You are reading this leaflet because you and your orthopaedic surgeon have decided together that this procedure may be of some benefit to you. It is intended to help you understand the operation and what to expect if you decide to go ahead with the procedure.

We hope that it will assist in reducing any anxiety you may have, answer some of your questions and offer some practical advice.

It is not intended to be a comprehensive guide, and it is essential that you discuss any further queries that you may have with your consultant surgeon.

What is the medial patellofemoral ligament (MPFL)?

The knee cap (patella) is designed to help the muscles on the front of your thigh to straighten your leg. As you bend and straighten your leg, the patella glides in a groove at the end of your thigh bone (femur) known as the trochlear groove of the femur. Sometimes the patella can come out of the groove, with or without an injury to the knee. This can lead to ongoing recurrent patella instability, with a feeling that the patella may slide out of the groove when the knee moves (subluxations) or complete dislocations. This may be painful as it causes scuffing (wear) to the under-surface of the patella and may lead to the development of osteoarthritis.

To aid stability of the patella there are a number of soft-tissues that attach to it. The medial patellofemoral ligament (MPFL) is by far the most important structure and accounts for the majority of the stabilising strength. The MPFL is a thin strip of tissue that attaches from the inside edge of your patella to the inner side of the lower end of your femur. It acts as an anchor and helps prevent the patella from sliding out of its groove.

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If your patella feels unstable or is regularly dislocating this can sometimes be improved by strengthening the muscles around the knee using physiotherapy. If this does not provide much improvement for you, reconstruction of the MPFL may help improve the stability of your patella.

What is MPFL reconstruction?

Surgical reconstruction of the MPFL is carried out under a general anaesthetic. It is a minimally invasive procedure and will require only a few small incisions on the front and side of your knee. A small camera will be used to look inside your knee and to repair any other damage that may be found in the joint.

One of your hamstring tendons (from the muscles on the back of the thigh) will be used to reconstruct the new ligament and will be harvested through one of the small incisions that have been made. It will cause a small reduction in the strength of the hamstring muscle (less than 10% loss of power). This generally goes unnoticed and will not stop you from carrying on with your day to day and sporting activities. The new ligament is secured by passing it through a small tunnel made on the inner edge of the patella and then fixing it to a short tunnel in the inner side of the femur. We take x-rays during the operation to confirm correct placement of the tunnel in the femur. Great care is taken not to under or over tighten the ligament so that it can effectively carry out its new job. The soft tissues that attach to the outside edge of the patella are sometimes also divided to prevent the outwards pull on the patella. This is known as a lateral release.

Once the new ligament is in place the knee will be washed out thoroughly and the small cuts will be closed. Lots of local anaesthetic is injected into the knee and around the incisions so your knee should be comfortable when you wake up. The knee will then be bandaged and you will be sent to the recovery room to wake up from the anaesthetic.

What are the benefits and outcomes of the surgery?

The aim of the procedure is to prevent the feeling of instability (giving way) and the recurrent dislocations that occur when the MPFL is disrupted. This is usually an extremely successful operation with high levels of satisfaction for those who undergo this surgery. Around 90-95% of people who undergo MPFL reconstruction are happy with the outcome.

What are the risks of surgery?

As with any operation, there are potential risks involved but the chances of complications occurring is very low. You will also be required to sign a consent form by your surgeon during which time any surgical risks will be explained to you in full. These include common risks of any surgical procedure around the knee such as:

• Wound problems such as slow healing + oozing ................
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