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MPFL Reconstruction (Medial Patellofemoral Ligament)

Anatomic reconstruction of the medial patellofemoral ligament using autograft (gracilis, semitendinosus) for recurrent patellar instability, with double-bundle technique and precise femoral and patellar fixation.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Ortopedi ve Travmatoloji department. Book Appointment →

What is MPFL Reconstruction (Medial Patellofemoral Ligament)?

MPFL anatomy: trapezoidal ligament originating from medial femoral condyle (between adductor tubercle and medial epicondyle, just distal-anterior to adductor tubercle), inserting on superomedial patella with two bundles (superior and inferior), spanning approximately 50-65 mm. Functions as primary medial restraint to lateral patellar translation in 0-30° of knee flexion.

Indications for MPFL reconstruction: recurrent patellar dislocation/subluxation (≥2 episodes), apprehension on physical examination, MPFL injury on MRI without major bony pathology that would otherwise require addressing. Often combined with TTO (tibial tubercle osteotomy) for TT-TG >20 mm or trochleoplasty for severe trochlear dysplasia in complex cases.

Pre-operative evaluation: clinical examination (apprehension, glide test, J-sign), imaging (lateral X-ray for Caton-Deschamps and Insall-Salvati, Merchant view for sulcus angle, CT or MRI for trochlear dysplasia grading and TT-TG), MPFL injury location (femoral 50%, mid-substance 25%, patellar 25%).

Symptoms

Recurrent patellar dislocation or subluxation
Patellar apprehension at 30° flexion
Lateral retinacular laxity
Sensation of giving way
Pain after dislocation episodes
Functional limitation in sports, stairs, squatting
MRI evidence of MPFL injury (medial femoral condyle bone bruise, ligament discontinuity)

Risk Factors

Recurrent patellar dislocation (>1 episode)
Failed non-operative management after first dislocation
MPFL injury location on MRI (femoral or patellar, mid-substance)
Generalized ligamentous laxity (Beighton score)
Female gender
Adolescent age group
No major bony pathology (otherwise combined procedures needed)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Recurrent patellar dislocations or subluxations
  • Apprehension and functional limitation despite physiotherapy
  • MPFL injury identified on MRI
  • Failed conservative treatment after first dislocation
  • Orthopedic and sports medicine surgical consultation

Treatment Methods

01
Surgical technique — graft selection: ipsilateral gracilis tendon (most common, sufficient strength and length, lower donor morbidity), semitendinosus (alternative), allograft (reduced operative time, no donor morbidity, but cost and integration concerns), quadriceps tendon (emerging)
02
Patellar fixation: two transverse tunnels at superior 1/3 of medial patellar border, anchor or interference screw fixation; or single longitudinal tunnel; soft tissue fixation with sutures and anchors; double-bundle reconstruction provides anatomic recreation
03
Femoral fixation point: Schöttle's point — radiographic landmark on lateral fluoroscopy 1 mm anterior to posterior femoral cortex extension and proximal to perpendicular line through posterior aspect of Blumensaat's line, at the level of the posterior origin of the medial femoral condyle. Critical to graft isometry — too proximal = tight in flexion (limits flexion, anterior knee pain); too distal = tight in extension
04
Graft tensioning: knee at 30° flexion, patella centered in trochlear groove, graft tensioned firmly but not over-tight (over-tension leads to medial overload and patellofemoral pain), assess full range of motion before final fixation
05
Combined procedures: TTO for TT-TG >20 mm (Elmslie-Trillat medialization, Fulkerson anteromedialization for combined patella alta and lateral facet chondrosis), trochleoplasty for severe trochlear dysplasia (Bereiter, Dejour deepening), distalization for patella alta
06
Pediatric considerations: avoid femoral tunnel through open physis; use adductor magnus tendon redirection (Avikainen, Schöttle modifications) or modified medialization; risk of growth disturbance
07
Postoperative rehabilitation: brace 4-6 weeks (extension to 30-90° progressive), partial then full weight-bearing, progressive ROM (0-90° first 4 weeks, then beyond), VMO and core strengthening, neuromuscular control, return to sport at 6-9 months
08
Postoperative complications: graft failure or stretching, persistent apprehension (5-10%), patellofemoral pain (often from graft over-tension or non-anatomic placement), patella fracture (rare), infection, knee stiffness (arthrofibrosis), hardware irritation
09
Revision surgery: graft failure, persistent instability — re-evaluate and address bony abnormalities (TTO, trochleoplasty); revision MPFL with allograft typically
10
Outcome assessment: Kujala anterior knee pain scale, Lysholm score, Tegner activity scale, return-to-sport rate, redislocation rate (<5% in well-selected cases), patient satisfaction
11
Long-term: 85-95% success at 5-10 years in appropriately selected patients; lower success rates with major bony abnormalities not addressed; chondromalacia progression possible; functional level often returns to pre-injury for most patients
12
Patient counseling: importance of postoperative rehabilitation compliance, timeline for return to activity, risk of redislocation, need for combined procedures in some cases, possibility of contralateral knee involvement

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.