An Overview on Lateral Patellar Instability and the Need for MPFL Reconstruction
The knee joint is a complex system of articular cartilage, ligaments, tendons and bone that allow it to withstand a great amount of stress during daily and athletic activities. One of these important structures is the medial patellofemoral ligament (MPFL). The MPFL plays an important role in kneecap stability by attaching the inside portion of the kneecap (patella) to the femur. An injury to the MPFL can occur in Los Angeles, California residents during a kneecap dislocation or subluxation, and lead to recurrent lateral patellar instability. If chronic kneecap dislocations occur because of damage or insufficiency of the MPFL, Dr. Mark Getelman, board certified knee surgeon with offices in Van Nuys and Thousand Oaks may recommend MPFL reconstruction to restore patellofemoral stability.
What is Lateral Patellar Instability?
Lateral patellar instability is commonly caused following a patella dislocation during athletic activities or other traumatic event. Due to the knee’s anatomy, a dislocation causes the patella to slip out of the groove on the femur toward the lateral (outside) aspect of the joint. The dislocation most often occurs at a shallow degree of knee flexion or with the joint at a straight angle, rarely at a bent angle. When a patella dislocation occurs, it often tears the MPFL and surrounding soft tissues and may lead to chronic instability and other troublesome symptoms.
Lateral Patellar Instability Symptoms
The hallmark symptoms of lateral patellar instability are the sensation of the patella slipping during turning and twisting movements, as well as kneecap pain or giving way with activity. Patients with this form of instability may also report a near kneecap dislocation or subluxation when the joint is close to a straight angle or full extended.
Lateral Patellar Instability Diagnosis
Following a kneecap dislocation, Dr. Getelman will perform a thorough evaluation and will diagnose the overall damage to the knee and the medial patellofemoral ligament. He will perform a thorough medical review and detailed physical examination to determine the degree of instability. A series of X-rays and an MRI are typically performed in order to view the affected knee in great detail, rule out other possible injuries and to confirm that the MPFL has been damaged and that reconstruction is necessary to return stability to the joint.
What is an MPFL Reconstruction?
Many patients may dislocate the patella and can do well with non-surgical measures. Dr. Getelman commonly prescribes conservative measures such as rest, modified activities, heat and cold therapy, bracing and rehabilitation exercises particularly after a first time dislocation.
However, patients who are young and are experiencing chronic dislocations of the patella, are often ideal candidates for a surgical MPFL reconstruction.
Medial patellofemoral ligament (MPFL) reconstruction is reserved for patients with recurring and serious kneecap dislocations. During the procedure, Dr. Getelman reconstructs the MPFL with a hamstring tendon from another part of the patient’s knee or from an allograft or donor tissue. The new ligament is created to stabilize the knee joint and to help protect from ongoing dislocations and additional damage.
Recovery after MPFL Reconstruction
A patient is placed in a knee brace or similar device for approximately 6 weeks following MPFL reconstruction in order to protect the reconstructed ligament. Knee motion is limited the first couple weeks, but full motion will be returned under the guidance of Dr. Getelman and a physical therapist. It is extremely important all rehabilitation protocols prescribed by Dr. Getelman are followed after surgery. The protocols are proven to provide an optimal recovery in the majority of patients if followed closely.
If you live in the Van Nuys, Thousand Oaks and Los Angeles, California area and would like additional information on lateral patellar instability and MPFL reconstruction, please contact the office of knee surgeon Dr. Mark Getelman.