All about MPFL Surgery (Recurrent Patellar Dislocation)

All about MPFL Surgery (Recurrent Patellar Dislocation)

by | Jul 5, 2025 | Health

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.