Patellar instability is a common problem among athletes, especially those involved in high impact sports such as basketball, soccer, or football. It is often caused by damage to the medial patellofemoral ligament (MPFL) – the primary stabilizing ligament of the patella. When this ligament is torn or stretched, it can result in patellar dislocation or subluxation, which can be debilitating and require surgical intervention. MPFL reconstruction is a surgical procedure that aims to repair or replace this damaged ligament, while physical therapy aims to promote healing and restore function.

MPFL Reconstruction

MPFL reconstruction is a surgical procedure that involves repairing or replacing the MPFL ligament using either autograft or allograft tissue. Autograft tissue is taken from the patient’s own body, typically from the hamstring or patellar tendon, while allograft tissue is harvested from a cadaver donor. Both options have their advantages and disadvantages, and the choice will depend on the individual patient’s needs.

The procedure is typically performed under general anesthesia and involves making an incision over the knee cap to access the patella and femur. The damaged ligament is then removed, and the replacement graft is secured to the femur and patella using anchors or screws. The goal of the surgery is to restore stability to the patella and prevent further dislocations or subluxations.

Physical Therapy following MPFL Reconstruction

Following MPFL reconstruction, physical therapy plays an important role in restoring range of motion, strength, and function to the knee joint. The exact physical therapy protocol will depend on the surgeon’s technique and the individual patient’s needs, but typically, physical therapy will begin within the first few days after surgery.

Initially, the focus will be on managing pain, swelling, and inflammation. This may involve the use of ice, compression, and elevation, as well as pain medication and anti-inflammatory drugs. As the patient progresses, the emphasis will shift towards promoting healing and restoring function.

Range of motion exercises will be introduced early on to prevent stiffness and maintain flexibility in the knee joint. This may involve passive range of motion exercises, where the therapist moves the patient’s leg through a range of motions, or active-assisted exercises, where the patient uses their own muscles with assistance from the therapist.

Strengthening exercises will also be introduced gradually, starting with isometric exercises and progressing to more challenging exercises as the patient heals. These exercises may include leg presses, squats, lunges, and step-ups, as well as exercises targeting the hip and core muscles.

Along with exercises, physical therapists may also employ other modalities such as ultrasound, electrical stimulation, or laser therapy to help promote healing and relieve pain.

Conclusion

MPFL reconstruction and physical therapy are essential components of the treatment of patellar instability. MPFL reconstruction aims to restore stability to the knee joint and prevent future dislocations or subluxations, while physical therapy aims to promote healing, restore range of motion, and strengthen the muscles surrounding the knee joint. With proper surgical intervention and postoperative rehabilitation, most patients are able to return to their pre-injury level of activity and avoid further complications.