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Medial Patello-Femoral Ligament Tears

Medial Patello Femoral Ligament (MPFL) is a ligament that is part of the complex network of tissues providing stability to the knee. It connects kneecap, also called Patella to the thigh bone (Femur). The lateral displacement of the kneecap (Patella) is prevented by MPFL and helps keep the position during the bending and straightening of the knee.

An injury to the knee can cause a tear in causing recurrent dislocation of the patella. An accident or trauma to the knee can cause the patella to be dislocated. This type of injury is usually seen during any sport related activity or a vehicle accident.

When the MPFL is injured or torn, the patella is released from any restraint and glides into a groove in the femur.

If the MPFL tear is left untreated, the ligament will heal into a looser and lengthened position, making it vulnerable for dislocations and can also cause damage to the knee’s cartilage. The symptoms of MPFL include pain, swelling and disability due to recurrent patellar dislocation. The damage to the cartilage can create a chance for Patellofemoral Arthritis.

The doctor usually prefers to first time dislocation with non-surgical methods and recurrent dislocations needs surgical reconstructive priocedures.

Non-Surgical Treatment
The initial injury ( first time dislocators) can be treated quickly without surgery by applying plaster to the knee, right after the accident. The knee is immobilized using splint and plaster for a couple of weeks to heal. Once the plaster is removed, the doctor might prescribe physical therapy and exercises to strengthen the knee muscles and to remove stiffness of the knee.

However, repeated injuries and instances of instability might need the help of surgical interventions to heal.

Surgical Treatment
The repeated kneecap instability and the ineffectiveness of the non-surgical method will make the doctor opt for surgery. The knee surgery depends on the extent of damage to the knee and other factors like the patient’s health, medications and the patient’s regular activity. The doctor might try to perform a repair procedure by reattaching the torn ligament to its original position on the bone.

The doctor might also go for MPFL Reconstruction surgery if the injuries are more complex. The surgery usually takes a couple of hours and the patient can be discharged either the same or next day with their knee in a brace. The patients can resume their normal activities within 3 to 6 weeks after the surgery.

In this procedure, the doctor takes a graft tissue from another part of the body and the replace the torn ligament with this graft. This procedure is a minimally invasive surgery called arthroscopy. The torn tissue in the joint is cleaned up and the ligament on the outside of the kneecap joint is loosened. Most of the patients experience great improvement in the kneecap joint’s stability after this surgery.

The Procedure
The patient undergoes general anaesthesia or spinal anesthesia that numbs the lower part of the body and the patient is sedated. The surgeon then performs surgery to replace the damaged ligament with a tendon, usually taken from the hamstring and then creates a new ligament. The damaged area is then inspected using the arthroscope and the reconstruction is completed with two small incisions.

Authored by Dr Banarji B.H - Shoulder Surgeon, Bangalore

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