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Medial Patellofemoral Ligament
Medial Patellofemoral Ligament (MPFL)
The Medial Patellofemoral Ligament (MPFL) is an hour-glass shaped ligament made of bands of retinacular tissue. The MPFL plays a significant role in the stabilization of the medial aspect of the patella. Especially during the early stages of knee flexion, the MPFL is a critical component in patellar tracking and stability within the trochlear groove. The medial patellofemoral ligament is located in the second layer of three soft tissue layers within the medial aspect of the knee. The MPFL originates from a triangular space running between the adductor tubercle, medial femoral condyle and gastconemius tubercle, superior to the superficial medial collateral ligament (MCL) The MPFL inserts onto the superomedial aspect of the patella. The proximal insertion extends to the quadriceps tendon while the distal insertion crosses deep to the distal vastus medialis obliquus (VMO)
Injury to the MPFL
In the healthy knee, the bones that make up the patellofemoral joint move smoothly against one another as the joint is flexed or extended. The patella glides in a trochlea (groove) of the femur. The MPFL plays a particularly important role in keeping the patella on track (that is, in this groove) by acting like a leash that restrains the patella’s movement.
When patellar dislocation occurs, soft tissues are damaged as the patella “jumps” the track and then comes forcibly back into place. Because the kneecap dislocates toward the outside of the leg, the ligament on the inside of the knee (the MPFL) gets torn.
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MPFL reconstruction as a revision to prior, unsuccessful surgeries
Orthopedic surgeons at the Patellofemoral Center also perform MPFL reconstruction on patients who have had other, less successful surgeries to address the condition. Such prior surgeries may include:
- Arthroscopic, minimally invasive surgery in which torn tissue in the patellofemoral joint is “cleaned up”
- Medial imbrication, a procedure in which the surgeon tightens the MPFL by taking a “tuck” in it, similar to tightening a garment.
- Lateral release, in which the ligament on the outside part of the patellofemoral joint is loosened
Although a lateral release alone is not an effective surgical option for patellar instability, this procedure may be done in conjunction with an MPFL reconstruction to address other problems in the joint and to restore balance in the knee.
Tubercle tibial transfer or osteotomy may also be done in conjunction with an MPFL in patients who have significant mal-alignment of the bones in the patellofemoral joint. This procedure is recommended for patients who have an anatomical abnormality in which the patella tendon attaches to the tibia in such a way that there is a severe sideways pull on the patella.
Those who undergo MPFL reconstruction as a revision surgery generally experience a considerable improvement in stability of the patellofemoral joint.
Treatment
Most first time MPFL injuries can be treated non-surgically with NSAIDs and immobilization. It’s then followed by physical therapy to strengthen the muscles around the knee. Your physician may recommend surgery if the injury is more severe, or if there are small pieces of detached bone or cartilage in the knee. MFPL reconstruction is often recommended for patients who experience repeated kneecap dislocations.
Depending on the patient’s individual condition, knee surgeons will either directly repair the ligament, or reconstruct the ligament. Surgeons will use a graft from another ligament in the patient’s own body or with that of a donor. 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.