Is MPFL Surgery Worth It? A Comprehensive Guide to Medial Patellofemoral Ligament Reconstruction

Introduction

Patellar instability can be a debilitating condition, causing pain, functional limitations, and recurrent dislocations. For many patients, medial patellofemoral ligament (MPFL) reconstruction has emerged as a promising surgical solution. But is MPFL surgery really worth it? Let's dive into the evidence and explore the pros and cons of this increasingly popular procedure.

What is MPFL Reconstruction?

The medial patellofemoral ligament is the primary soft tissue restraint preventing lateral displacement of the patella. MPFL reconstruction aims to restore stability by recreating this important anatomical structure using a graft. Hopper et al. (2022) describe it as a common procedure for recurrent patellar instability, often using autograft or allograft tissue.

Benefits of MPFL Surgery

Research has demonstrated several key benefits of MPFL reconstruction:

• Reduced redislocation rates: Liu et al. (2021) found that MPFL reconstruction led to significantly lower redislocation rates compared to MPFL repair or non-operative treatment.
• Improved knee function: Multiple studies have shown significant improvements in functional scores like the Kujala and Lysholm scales after MPFL reconstruction.
• High patient satisfaction: Berruto et al. (2014) reported an 88.8% overall satisfaction rate among patients undergoing MPFL reconstruction.

Potential Risks and Complications

While generally successful, MPFL surgery is not without risks:

• Persistent pain: Tanaka (2019) notes that complication rates after MPFL reconstruction can be as high as 25%, with medial knee pain being a common issue.
• Patellar fracture: This rare but serious complication can occur, especially with improper tunnel placement.
• Stiffness or loss of motion: Some patients may experience reduced knee flexibility post-surgery.

Who is a Good Candidate for MPFL Surgery?

MPFL reconstruction is typically recommended for patients with:

• Recurrent patellar dislocations (two or more episodes)
• Failed conservative treatment
• No significant malalignment or trochlear dysplasia

Enderlein et al. (2014) found that age over 30, obesity, cartilage injury, and female gender may predict poorer subjective outcomes.

Surgical Techniques and Innovations

MPFL reconstruction techniques continue to evolve:

• Graft choice: Options include hamstring tendons, quadriceps tendon, or synthetic grafts.
• Fixation methods: Surgeons may use suture anchors, interference screws, or adjustable-loop buttons.
• Anatomic placement: Precise tunnel positioning is crucial for optimal outcomes.

Strickland (2022) highlights the trend towards minimally invasive techniques and the potential benefits of using all-suture anchors for patellar fixation.

Recovery and Rehabilitation

Post-operative rehabilitation is critical for successful outcomes:

1. Initial protection phase (0-6 weeks): Focus on pain control, swelling reduction, and gradual range of motion exercises.
2. Strengthening phase (6-12 weeks): Progressive quadriceps and hip strengthening.
3. Functional phase (3-6 months): Sport-specific training and return to activities.

Full recovery can take 6-12 months, with most patients able to return to sports and pre-injury activity levels.

Long-Term Outcomes

Research suggests favorable long-term results for MPFL reconstruction:

• Gravesen et al. (2019) found a mean risk of persistent patellar morbidity of 20.9% at 8 years post-surgery, which was significantly lower than other stabilizing procedures.
• Multiple studies report high rates of return to sports and sustained improvements in knee function scores.

Conclusion

So, is MPFL surgery worth it? For many patients with recurrent patellar instability, the answer is a resounding yes. The procedure offers high success rates in preventing redislocation and improving knee function. However, it's not without risks, and patient selection is crucial. As with any surgery, it's important to have a thorough discussion with your orthopedic surgeon to determine if MPFL reconstruction is the right choice for your individual case. With proper indications, skilled surgical technique, and dedicated rehabilitation, MPFL reconstruction can be a game-changer for those struggling with patellar instability.