From the Guidelines
MPLF reconstruction is not mentioned in the provided evidence, however, based on general medical knowledge, it can be defined as a surgical procedure used to treat recurrent patellar instability or dislocation. This procedure involves rebuilding the damaged or insufficient Medial Patellofemoral Ligament (MPLF), which is the primary soft tissue restraint preventing lateral displacement of the patella. During the surgery, the surgeon typically harvests a tendon graft (often from the patient's hamstring, such as the gracilis or semitendinosus tendon) and anchors it to create a new ligament that mimics the function of the original MPLF. The graft is secured to the medial edge of the patella and to the femur at the anatomic insertion site of the native MPLF. This reconstruction helps restore normal patellar tracking within the trochlear groove of the femur, preventing further dislocations. Recovery typically involves immobilization for a short period, followed by progressive physical therapy focusing on range of motion exercises, quadriceps strengthening, and eventually return to full activities over 4-6 months. The procedure has a high success rate in preventing recurrent patellar dislocations, particularly in patients with normal bony anatomy, as supported by the general medical knowledge, although not specifically mentioned in the provided evidence 1. Some key points to consider in the context of reconstruction include:
- Patient preference and individual clinical situation
- Body habitus, smoking history, comorbidities, and plans for irradiation
- Expertise and experience of the reconstruction team, as mentioned in the context of breast reconstruction 1
- The importance of preoperative radiographic interpretation and intraoperative confirmation of resection borders, as mentioned in the context of osteoradionecrosis management 1. However, it is essential to note that these points are not directly related to MPLF reconstruction but are relevant to reconstruction procedures in general. In summary, MPLF reconstruction is a surgical procedure used to treat recurrent patellar instability or dislocation, and its success depends on various factors, including patient selection, surgical technique, and postoperative rehabilitation.
From the Research
Definition of MPFL Reconstruction
- MPFL reconstruction (MPFLR) is a surgical procedure aimed at repairing or reconstructing the medial patellofemoral ligament (MPFL), which is commonly injured during lateral patellar dislocation 2.
- The MPFL is considered the most important structure in preventing patellar dislocation, and its rupture accounts for 3% of total knee injuries 2.
Indications for MPFL Reconstruction
- History of multiple patellar dislocations is a relevant indication for ligament reconstruction, especially after a failed course of conservative treatment in the presence of persistent patello-femoral instability 2.
- MPFL reconstruction is an option for treating symptoms of patellar instability, preventing recurrent dislocation, and returning patients to their pre-injury level of activity 3.
Outcomes of MPFL Reconstruction
- Studies have shown that MPFL reconstruction results in lower redislocation rates and higher functional outcomes compared to rehabilitation 4.
- A systematic review and meta-analysis found that MPFL reconstruction resulted in a lower rate of redislocation (7%) compared to rehabilitation (30%) 4.
- MPFL reconstruction has been shown to provide improved midterm clinical outcomes and a decreased recurrence rate compared to MPFL repair 5.
Clinical Results of MPFL Reconstruction
- A case series study found that MPFL reconstruction showed a recurrence rate of 11.7%, with high patient satisfaction, good functional results, and a high rate of return to sports after a minimum of two years of follow-up 6.
- Patients who underwent MPFL reconstruction reported a high degree of satisfaction, with 96.08% stating they would undergo surgery again 6.