From the Research
Management of a first-time traumatic medial patellofemoral ligament (MPFL) rupture in an adult typically begins with conservative treatment unless there are specific indications for surgery. Initial management includes RICE protocol (rest, ice, compression, elevation) for 48-72 hours, followed by protected weight-bearing with crutches as needed. Pain control can be achieved with NSAIDs such as ibuprofen 400-600mg three times daily or naproxen 500mg twice daily for 1-2 weeks. Physical therapy should begin within 1-2 weeks, focusing on quadriceps strengthening, particularly the vastus medialis obliquus (VMO), range of motion exercises, and proprioception training. A hinged knee brace may be prescribed for 4-6 weeks to provide stability while allowing controlled motion. Most patients respond well to this conservative approach over 3-4 months.
Key Considerations
- Surgical intervention is generally reserved for cases with recurrent instability, large osteochondral fragments, substantial disruption of the extensor mechanism, or when the patient has anatomical risk factors for recurrence such as trochlear dysplasia or patella alta.
- The conservative approach is preferred initially because the MPFL has some healing capacity, and strengthening the dynamic stabilizers (particularly the VMO) can compensate for ligamentous laxity, potentially avoiding the risks associated with surgery while achieving satisfactory functional outcomes.
- A recent study 1 comparing MPFL repair and reconstruction for recurrent lateral patellar instability found that MPFL reconstruction resulted in a significantly lower rate of recurrent dislocation at long-term follow-up, suggesting that reconstruction may be a better option for patients with recurrent instability.
Treatment Approach
- Initial conservative management with RICE protocol, pain control, and physical therapy
- Consider surgical intervention for recurrent instability or anatomical risk factors
- MPFL reconstruction may be a better option for patients with recurrent instability, based on recent evidence 1
Important Evidence
- A study published in 2018 2 reviewed the management of MPFL injuries and highlighted the importance of providing patellar stabilization and restoring normal kinematics throughout the joint.
- Another study published in 2024 1 compared the failure rates of MPFL repair and reconstruction for recurrent lateral patellar instability and found that reconstruction had a lower failure rate and similar clinical outcomes.