From the Guidelines
The management of a first-time medial patellofemoral ligament (MPFL) rupture in an adult should prioritize a conservative, non-surgical approach, focusing on knee-targeted exercise therapy, education, and supporting interventions to address individual impairments and promote recovery. This approach is supported by recent expert consensus and clinical reasoning, as outlined in a 2024 study published in the British Journal of Sports Medicine 1. The initial evaluation should objectively assess physical impairments, including muscle strength, movement patterns, tissue tolerance to load, and patellofemoral joint structure and function, as well as contextual factors related to symptoms 1. Key components of the management plan include:
- Delivering knee-targeted exercise therapy, with a focus on hip exercises in individuals with poor tolerance to loaded knee flexion, and modifying task, load, intensity, and frequency as required 1
- Providing education to challenge inaccurate beliefs, build confidence, and promote understanding of the diagnosis and recovery journey 1
- Considering supporting approaches, such as prefabricated foot orthoses, movement retraining, and taping, based on individual needs and response to treatment 1
- Regular follow-up and reassessment to determine progress and adjust the management plan as needed. By prioritizing a conservative, individualized approach, clinicians can promote optimal recovery, reduce morbidity, and improve quality of life for adults with a first-time MPFL rupture.
From the Research
Management of First-Time Medial Patellofemoral Ligament (MPFL) Rupture in Adults
The management of a first-time medial patellofemoral ligament (MPFL) rupture in an adult can be approached through various methods, including conservative rehabilitation and surgical intervention.
- Conservative rehabilitation is usually the first line of defense following an acute dislocation 2.
- However, in cases where conservative measures fail, surgical intervention may be necessary, with various techniques available for MPFL reconstruction 3.
- The goal of treatment is to provide patellar stabilization and restore normal kinematics throughout the joint 3.
Surgical Intervention
Surgical intervention for MPFL rupture can involve either repair or reconstruction of the ligament.
- A study comparing MPFL repair and reconstruction found that reconstruction resulted in a significantly lower rate of recurrent dislocation at long-term follow-up 4.
- The study recommended MPFL reconstruction over repair due to the lower failure rate and similar clinical outcomes 4.
- However, another study found that patellar MPFL avulsion injuries do not benefit from acute surgical repair compared to nonsurgical treatment, except in cases where there is an osteochondral fracture 5.
Rehabilitation
Rehabilitation following MPFL reconstruction is crucial for a successful outcome.
- A case series described a post-surgical physical therapy management program for MPFL reconstructions, which included proprioceptive-focused and dynamic rehabilitation, along with a home exercise program 6.
- The program resulted in excellent outcomes for return to activity/sport, with all subjects scoring over 80 on the Modified Cincinnati Knee Outcome Measure (MCKOM) 6.