Patellar stabilization with tunnelless medial patellofemoral ligament (MPFL) reconstruction is used for patients who continue to experience instability and recurrent patellar dislocations despite conservative treatment and physical therapy.
Dr. Chudik prefers to preserve the normal anatomy by anatomically reconstructing the MPFL without drilling tunnels or cutting bone. The reconstruction uses a tendon graft, usually a hamstring tendon from the same knee, secured to the femur and patella with small anchors.
What Is Anatomic Tunnelless MPFL Reconstruction?
When the patella (kneecap) dislocates, structures on the medial side of the patella are torn.
After a dislocation, some patients can rehabilitate the knee with physical therapy and return to activities without recurrent dislocations. Others continue to experience instability and repeated dislocations. Each dislocation also carries a risk of associated cartilage injury in the knee.
After conservative treatment and physical therapy, surgery to reconstruct the MPFL may be recommended when recurrent dislocations continue.
There are many surgical techniques used to treat recurrent patellar dislocations. Some require drilling tunnels or cutting bones and tissues to realign how the patella tracks along the femur. Dr. Chudik prefers to preserve the normal anatomy and reconstruct the MPFL without drilling tunnels or cutting bone.
A tendon graft, usually a hamstring tendon from the same knee, is used to create a new MPFL and is secured to the femur and patella with small anchors.
Development Rationale
Many surgical techniques for recurrent patellar dislocation require drilling tunnels or cutting bones and tissues to change how the patella tracks along the femur. These procedures alter the normal anatomy and can increase the risk of developing arthritis.
Dr. Chudik prefers to preserve the normal anatomy by anatomically reconstructing the MPFL without drilling tunnels or cutting bone. The goal is to stabilize the patella and prevent further dislocations while preserving the patient’s anatomy.
Who Is a Candidate?
MPFL reconstruction may be recommended for patients who continue to experience instability and recurrent patellar dislocations after conservative treatment and physical therapy.
Contraindications include:
- Inability or unwillingness to complete the postoperative rehabilitation program
- Current or previous knee infection, although this is not an absolute contraindication
- Severe knee or patellofemoral arthritis
How the Procedure Is Performed
The procedure is performed as outpatient surgery, allowing the patient to go home the same day. General anesthesia and an adductor nerve block may be used.
Dr. Chudik anatomically reconstructs the MPFL without drilling tunnels or cutting bone.
A tendon graft, usually a hamstring tendon from the same knee, is used to create a new MPFL. The graft is secured to the femur and patella with small anchors to stabilize the patella and help prevent further dislocations.
Recovery and Rehabilitation
Following surgery:
- Crutches are used for comfort, with weight bearing as tolerated
- The wound should be kept clean and dry for the first 10 to 14 days
- Light showering is allowed after two weeks, but the wounds should not be submerged in water for three weeks
- Driving may resume after six weeks when the right leg is involved
- Return to school or sedentary work may occur in less than one week as long as the leg can be elevated
- Physical therapy to restore motion, strength, and proprioception (balance) may continue for four to six months
- Quadriceps muscle-preserving exercises must begin immediately after surgery
After the knee is fully rehabilitated, Dr. Chudik performs Knee Return to Sport Testing to determine whether rehabilitation is complete and whether movement patterns known to increase the risk of knee injury have been corrected before returning to activities.
Minimal daily walking and regular daily activities are opened up to allow motion at approximately four to six weeks after surgery. Return to running may occur at about four to six months, with return to sports at approximately four to six months.
Risks and Outcomes
Potential risks and complications include:
- Infection or injury to nerves, resulting in numbness of the knee, leg, or foot
- Swelling or continued knee pain
- Re-injury of the reconstruction with recurrent patellar dislocation
- Knee stiffness or loss of motion
- Muscle weakness
- Recurrent dislocation or subluxation of the patella
- Rarely, a blood clot in the veins of the calf or thigh that may travel to the lungs
The goal of the procedure is to stabilize the patella and prevent further dislocations while preserving normal anatomy.
Why Dr. Chudik for Anatomic Tunnelless MPFL Reconstruction
Dr. Chudik prefers to preserve the normal anatomy when treating recurrent patellar dislocations. His approach anatomically reconstructs the MPFL without drilling tunnels or cutting bone.
The reconstruction uses a tendon graft secured to the femur and patella with small anchors to create a new MPFL, stabilize the patella, and help prevent further dislocations.
Following rehabilitation, Dr. Chudik uses Knee Return to Sport Testing to evaluate whether the knee is fully rehabilitated and whether movement patterns associated with knee injury risk have been corrected before returning to activities.