This point was most isometric, with a mean maximal length change to the central patellar attachment of 2. The proximal femoral attachment resulted in up to 6.
Conclusion: We report the anatomic femoral and patellar MPFL graft attachments, with confirmation of the reproducibility of their location and resulting kinematic behavior. Nonanatomic attachments caused significant loss of isometry. Clinical relevance: The importance of an anatomically positioned MPFL reconstruction is highlighted, and an identifiable radiographic point for femoral tunnel position is suggested for use intraoperatively.
This will provide stabilization to the knee and will allow the patient to return to normal activity. Typically, MPFL reconstruction is performed at an outpatient facility. The knee will be immobilized while walking and standing for a period of six weeks, followed by a program of physical therapy. Patients usually return to normal activity after a period of four to six months. The surgery takes approximately minutes to perform. The surgery is usually performed as a day surgery.
When you wake up you will have a bandage on your knee. You will be seen by the physiotherapist and instructed on how to use crutches. You will be allowed to take full weight on your leg.
Crutches are normally only required for approximately days following the operation, and are used mainly to protect your knee from collapsing whilst the soft tissues are healing. The main aims of early rehabilitation include reducing swelling, applying compression to the knee, elevating your leg and gently tightening muscles so as to minimise any muscle wasting.
You will be asked to see your physiotherapist for regular visits, often times a week for the first few weeks and then once a week following this. The main aims of physiotherapy in the early period are to restore some motion of the knee joint, reduce swelling and maintain muscle strength. A specific rehabilitation program will need to be given to your physiotherapist so as they comply with the instructions required for such an operation. This will be given to your by your surgeon following your operation.
A patellofemoral stabilising brace is required after MPFL reconstructive surgery whilst the ligament heals. This is used for the first weeks following surgery. This should be fitted and arranged prior to your operation.
It is common to have some pain after surgery but this will be controlled with regular anti-inflammatory medications for the first five days. You will also be given other medications that can be taken as required to reduce pain. As a general rule, pain is not severe immediately following the surgery as local anaesthetics are used at the time of the operation to reduce significant pain during the early postoperative period. These are administered whilst you are having the operation. It is important to ice your knee regularly, 20 minutes every hour during the first few days, as this also reduces inflammation and decreases pain.
It is normal to have swelling following the operation and some bruising around the leg. Swelling and bruising can occasionally be seen around the ankle and this should not cause concern. Your knee will feel stiff and it is important to gently bend your leg following surgery to overcome this sensation. This will also be worked on with your physiotherapist. As there are several incisions around the knee, it is common to have areas of numbness surrounding those cuts.
These patches of numbness generally dissipate with time. This will generally diminish with time but a very small percentage of patients have a permanent area of numbness over the outer side of the leg. In our experience, this has never been incapacitating to patients. You will also notice that the quadriceps muscle at the front of your knee will decrease atrophy in size following your operation.
This is experienced by all patients and will recover with appropriate exercise and rehabilitation. It can take many months for this muscle to fully recover and its return in size and strength is a major determining factor on when you can return to full activities. Most patients require approximately weeks off work if they work in an office setting and anywhere between three and five weeks if they work in manual labour.
This obviously needs to be discussed with your surgeon prior to surgery. Most people who have this surgery are able to return to normal activities, including sport.
In a small group of patients, additional operations are required in conjunction with medial patellofemoral ligament reconstruction to assist in stabilising the patella. Please see separate section on tibial tubercle osteotomy, which addresses this component of the surgery in more detail. Figure 1. Patellofemoral instability. Figure 2.
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