All about MPFL Surgery (Recurrent Patellar Dislocation)

Jul 5, 2025 | Health

By Dr. Chirag Arora

MPFL Repair

ALL ABOUT MPFL SURGERY (RECURRENT PATELLAR DISLOCATION)

Here is a comprehensive guide to MPFL (Medial Patellofemoral Ligament) surgery, covering anatomy, indications, surgical options, techniques, recovery, risks, and return to activity.Whether you’re a patient, student, or clinician, this gives you everything you need to understand MPFL surgery.

What is the MPFL?

• The Medial Patellofemoral Ligament (MPFL) is a band of tissue (ligament) connecting the inner side of the kneecap (patella) to the thigh bone (femur).
• It prevents the kneecap from dislocating laterally (outward)—especially in early knee flexion (0–30°).

Why is MPFL Surgery Needed?

INDICATIONS:

• Recurrent patellar dislocations or subluxations
• Patellar instability that fails conservative treatment (PT, bracing)
• Congenital laxity or anatomical abnormalities (e.g., trochlear dysplasia, patella alta)
• In association with other ligament injuries

Types of MPFL Surgery

1. MPFL Repair

• The torn ligament is reattached to bone (femur or patella).
• Best for first-time dislocation with good-quality tissue in acute (<3 weeks) scenario

2. MPFL Reconstruction (most common done in adults)

• A new ligament is created using a graft (usually hamstring tendon).
• Preferred for recurrent dislocations, poor-quality ligament, failed prior surgery or chronic conditions

POSTOPERATIVE PROTOCOL (SUMMARY)

Timeline

                            Focus Area

Week 0–2

Pain control, swelling  reduction, ROM 0–30°

Week 2–6

Gradual ROM (goal: 0–90 +), begin weight-bearing

Week 6–12

Full ROM, strength building, balance

3–5 months

Jogging, light agility work

6–9 months

Sport-specific rehab and return

Crutches: not used in our practice
Brace: 2-4 weeks (locked in extension at first) – our protocol
Ice & elevation: First 2–3 weeks

Return to Activity (Rough Guidelines)

Activity

              Approximate Timeline

Walking normally

                         2 weeks

Return to office

                         7-10 days

Climbing stairs

                         4- 6 weeks

Full ROM

                         4-6 weeks 

Stationary biking

                       ~ 4 weeks

Jogging

                       ~ 6-8 weeks

Cutting/agility drills

                       ~3-4 months

Return to sport

                        6–9 months (depends                               on sport)

Success Rate & Outcomes

• Success rate: ~95 -99% for restored stability
• Most patients return to normal activity, including sports
• Better long-term results in younger, active patients with a structured rehab plan

    Key Takeaways

    • MPFL surgery is highly effective for chronic patellar instability.
    • MPFL reconstruction is the gold standard for adults with recurrent dislocation.
    • Recovery is progressive and must be closely guided by a physical therapist.
    • Long-term success depends on proper rehab, graft positioning, and avoiding early return to sport

    MPFL Reconstruction Rehab Plan

    General Guidelines (IN OUR PRACTICE)

    • Brace: Usually locked in extension for 2 weeks, then unlocked gradually.
    • Weight Bearing: Partial (if req) → full weight bearing over 2– weeks.
    • Timeline: Full recovery typically takes 6 months.
    • Focus: Controlled range of motion (ROM), quad activation, avoiding patellar overload.

    Phase 1: Protection & Early Motion (Weeks 0–2)

    Goals:

    • Protect surgical site
    • Control pain/swelling
    • Begin gentle motion

    • Activate quadriceps

    Protocol:

    • Brace: Locked in full extension for ambulation
    • Weight Bearing: Mostly full wt bearing
    • ROM: 0–30° (progress to 60° by end of week 2)
    • Modalities: Ice, elevation, compression

    Precautions:

    • Avoid active knee flexion against resistance
    • No weight bearing without brace locked

      Phase 2: Controlled Mobility (Weeks 2–6)

      Goals:

      • Achieve 90°–120° knee flexion
      • Normalize gait with brace

      • Improve quad control

      Protocol:

      • Brace: Unlocked gradually after week 2
      • Weight Bearing: Progress to full as tolerated
      • ROM Goal: 0–120° by week 6
       

      Precautions:

      • Avoid open-chain knee extension >30°
      • Watch for anterior knee pain with loading

        Phase 3: Strengthening & Neuromuscular Control (Weeks 6–12)

        Goals:

        • Full ROM (0–135°)
        • Good patellar tracking

        • Improve dynamic strength and balance

        Exercises:

        • Leg press (0–60°)
        • Wall sits
        • Step-ups and controlled step-downs
        • Balance board and BOSU drills

        • Bridges on stability ball

        Activity:

        • Elliptical

        • Pool walking or deep water jogging (if incision healed)

        Avoid:

        • Jumping, pivoting, or twisting drills

         

          Phase 4: Sport-Specific Rehab (Months 3–6)

          Goals:

          • Symmetrical strength and movement patterns
          • Pain-free cutting, pivoting

          • Prepare for return to sport

          Drills:

          • Cone drills
          • Carioca steps
          • Acceleration/deceleration
          • Jump/hop landing mechanics

          • Agility ladders, shuttle runs

          Testing:

          • Y-Balance
          • Single-leg hop tests
          • Isokinetic strength testing

           

            Phase 5: Return to Sport (Months 6–9)

            Goals:

            • 90–95% strength compared to other leg
            • Full functional control

            • Surgeon & PT clearance

             

            Activities:

            • Gradual return to:
            o Jogging → sprinting
            o Practice → scrimmage → full competition


            Most athletes return to sport             around month 6–8, depending on the sport and healing.
            Regain confidence in movement with expert MPFL care by Dr. Chirag Arora, the leading orthopedic doctor in Gurgaon. Book your consultation for lasting relief today.

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