All about MPFL Surgery (Recurrent Patellar Dislocation)

All about MPFL Surgery (Recurrent Patellar Dislocation)

ALL ABOUT MPFL SURGERY (RECURRENT PATELLAR DISLOCATION)

Here is a comprehensive guide to MPFL () 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 .

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 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.

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. (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 . Book your consultation for lasting relief today.

              What to do (on field) after an Acute Shoulder Dislocation?

              What to do (on field) after an Acute Shoulder Dislocation?

              WHAT TO DO (ON FIELD) AFTER AN ACUTE SHOULDER DISLOCATON?

              Here’s a general roadmap for what to do after a shoulder dislocation. Keep in mind every case is unique—always follow the advice of the shoulder specialist/physician.

              1. Seek Immediate Medical Evaluation

              • Reduction by a Professional
                A dislocated shoulder should only be put back in place (“reduced”) by a trained clinician. Attempting self-reduction can damage nerves, blood vessels, and the joint surfaces.
              •  Neurovascular Exam & Imaging
                After reduction, your doctor will check your pulses, sensation, and motor function in the arm, and will usually obtain X-rays (and sometimes MRI or CT) to confirm the joint is back in place and rule out associated or soft-tissue injuries.

              2. Acute Care (First 1–2 Weeks)

              • Instability assessment is done by your shoulder specialist/
              • Immobilization (not usually required, unless very unstable : assessed by your shoulder specialist)
                You’ll typically wear a sling (sometimes with an abduction pillow) for 2 weeks, depending on your age, activity level, and whether it’s a first-time or recurrent dislocation.
              • Pain & Swelling Control
                       o Ice the shoulder for 15–20 minutes every 2–3 hours.
                       o Take NSAIDs (e.g., ibuprofen) or acetaminophen as directed for pain relief.
              • Gentle Pendulum Exercises
                Starting around day 3–5, you can do small “pendulum” swings: lean forward, let the arm hang, and gently circle it 10 times in each direction. This helps prevent stiffness.
              • In our practice, we always do a MRI assesment to ascertain the extent of damage and predict the chances of recurrence.

              3. Early Rehabilitation (Weeks 2–6)

              • Passive & Assisted Range of Motion
                Under guidance, you’ll begin to gently move the shoulder within a pain-free range—often with the help of your opposite arm or a therapist.
              • Avoid Risky Positions
                Do not force external rotation or full overhead reaching until your surgeon/therapist gives the go-ahead.
              • Isometric “Pre-Strengthening”
                Begin light, static muscle contractions (pushing your hand gently against a wall) to maintain muscle activation without joint movement.

              4. Progressive Strengthening and return to sports (Weeks 6–12)

              • Active Range of Motion (AROM)
                You’ll work on moving the shoulder through its full, pain-free range under your own muscle power.
              • Resisted Exercises
                Using light resistance bands or small weights, focus on the rotator cuff muscles (supraspinatus, infraspinatus, subscapularis) and the scapular stabilizers (serratus anterior, trapezius).
              • Proprioception & Neuromuscular Control
                Exercises like ball-throws against a wall, rhythmic stabilizations, and weight-bearing on the elbows can help retrain joint sense and stability.

              5. Prevention of Recurrence

              • Maintain Rotator-Cuff & Scapular Strength
                Ongoing strengthening of the “dynamic stabilizers” is the single best way to protect your shoulder from future .
              • Avoid High-Risk Positions
                Be cautious with extreme external rotation + abduction (“cocking” phase) in overhead sports until full strength and control are restored.
              • Regular Check-Ins
                Periodic follow-ups with your therapist or surgeon help catch any weakness or range-of-motion deficits early.

              Important Reminders

              • Follow-Up is Crucial: Stick to your appointment schedule for imaging and therapy progress checks.
              •  Listen to Your Body: Mild discomfort is normal when rebuilding strength, but sharp pain or feelings of instability warrant immediate rest and re-evaluation.
              • Individual Variability: Timelines may be shorter or longer depending on your age, tissue quality, if it’s your first versus a recurrent dislocation, and concomitant injuries (e.g., Bankart lesions, Hill–Sachs defects).
              • Recurrent dislocations (>3) may require surgical treatment.

                Always refer to the tailored plan your healthcare team prescribes. If you ever feel your shoulder “giving way” or if pain/swelling spikes suddenly, seek medical attention right away.

                DISCUSS YOUR TREATMENT PLAN IN DETAIL WITH A SHOULDER/SPORTS  SPECIALIST FOR RETURN TO SPORTS

                 

              An Orthopaedic’s Guide to Preventing Sports Injuries

              An Orthopaedic’s Guide to Preventing Sports Injuries

              Being active and playing sports is great, but sports injuries can stop anyone, from casual players to serious athletes. As an Orthopaedic surgeon who treats these injuries often, I know how much they can affect your goals and . Prevention is always better than care, instead of getting hurt. Luckily, taking smart steps based on medical knowledge can lower your chances of getting hurt. This blog offers simple, proven tips to help you stay active, reach your fitness goals, and most importantly, avoid injuries.

              Common Sports Injuries

              Some of the common could be:

              • Sprains & – A sprain happens when the tough bands around your joints (ligaments) get stretched too far or even tear. This usually occurs when you suddenly twist, fall, or get hit in a way that bends your joint too much. Possible symptoms could be immediate, often sharp pain, along with swelling, bruising, tenderness, and difficulty in moving or bearing weight, with severity ranging from a mild stretch to a complete ligament tear. Strains are injuries where muscles or the tendons connecting them to bones get stretched or torn, usually from overstretching, sudden strong muscle contraction, or doing the same movement too many times.
              • – Joint injuries, particularly in the knee, are common in sports because the knee is a complicated joint that handles a lot of force and twisting. These injuries often involve the strong bands called ligaments (like the ACL, MCL, PCL, and LCL), which can tear from sudden stops, turns, or hits. This causes pain, swelling, makes the knee feel wobbly, and makes it hard to move. Another common knee problem is a tear in the cartilage cushions called menisci, which can happen from twisting or getting hit. This can lead to pain, swelling, a clicking feeling, and sometimes the knee can even get stuck.
              • – Muscle injuries extend beyond strains to include contusions (bruises), which result from direct impacts to a muscle, damaging tissue and blood vessels and leading to localized pain, swelling, and the visible discoloration of a bruise. More significant are severe muscle tears, which occur due to sudden, powerful contractions or extreme overstretching. These injuries are characterized by sharp, immediate pain, a noticeable loss of strength in the muscle, and sometimes a physical gap or indentation that can be felt within the muscle tissue.
              • Dislocations– Dislocations occur when bones in a joint are forced out of their normal alignment due to significant impact or falls, causing intense pain, visible deformity, immobility, and often requiring medical intervention to realign the joint.  
              • Fractures – A fracture is a break or crack in a bone. In sports, these injuries can occur acutely from a forceful impact, resulting in immediate pain, swelling, and difficulty using the affected area. Alternatively, fractures can develop gradually due to repetitive stress on a bone, known as , which cause pain that worsens over time.

              Tips to Prevent Sports Injuries

              1. Always Properly: Before you start any sport or exercise, take some time to get your body ready. This means doing light movements and stretches that get your blood flowing and your muscles warm.
              2. Use Good Technique: Learning the right way to do things in your sport is very important. Whether it’s how you throw a ball, run, or lift weights, using the correct form makes sure you’re using your body efficiently and not putting too much pressure on one part. A coach or instructor can help you with this.
              3. Increase Slowly: Don’t try to go from doing nothing to playing intensely every day. Your body needs time to get stronger and adjust to new activities. Gradually increase how often you play, how long you play, and how hard you push yourself. This helps prevent overuse injuries.
              4. Wear the Right : Depending on your sport, this could include helmets, pads, braces, and supportive shoes. These things are designed to absorb impact and protect vulnerable parts of your body from injury. Make sure your gear fits well and is in good condition.
              5. Stay Well Hydrated and Eat a Balanced Diet: Your muscles and bones need water and nutrients to function properly and recover. Being dehydrated or not eating well can make you more prone to fatigue and injury. Think of it as giving your body the right fuel to perform and repair itself.
              6. Listen Carefully to Your Body: Pain is your body’s way of telling you something isn’t right. Don’t ignore aches and pains, especially if they’re sharp or persistent. Pushing through pain can make a small problem much worse. Rest when you need to.
              7. Get Enough : Your body needs time to repair and rebuild after exercise. Make sure you’re getting enough sleep and incorporating rest days into your training schedule. This prevents , which can weaken your body and make you more susceptible to injuries.
              8. Don’t Hesitate to Seek Professional Advice: If you have recurring pain, are starting a new sport, or want personalized advice on preventing injuries, you can consult Dr. Chirag Arora, Sports Injury surgeon in Gurgaon for expert advice.

              Conclusion

              Enhancing an active lifestyle and participating in sports offers significant benefits. However, sports injuries can unfortunately interrupt these pursuits. By understanding common injuries and consistently applying preventative measures like proper warm-up, good technique, gradual progression, using protective gear, staying hydrated, listening to your body, and prioritizing rest, you can substantially reduce your risk of being sidelined. Taking these proactive steps is key to enjoying your favorite activities safely and maintaining a healthy, active life for years to come.