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What Is Medial Patellofemoral Ligament Reconstruction?

Medial patellofemoral ligament reconstruction is knee surgery that rebuilds the main soft-tissue restraint preventing the kneecap from dislocating laterally. The medial patellofemoral ligament connects the inner side of the patella to the femur and is commonly injured during a lateral patellar dislocation. Reconstruction uses a tendon graft to recreate this stabilizing structure. The goal is to guide the patella more securely within the trochlear groove during knee motion.

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What Is Medial Patellofemoral Ligament Reconstruction?

Medial patellofemoral ligament reconstruction is knee surgery that rebuilds the main soft-tissue restraint preventing the kneecap from dislocating laterally. The medial patellofemoral ligament connects the inner side of the patella to the femur and is commonly injured during a lateral patellar dislocation. Reconstruction uses a tendon graft to recreate this stabilizing structure. The goal is to guide the patella more securely within the trochlear groove during knee motion.

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Why Is Medial Patellofemoral Ligament Reconstruction Performed?

The procedure is commonly used for recurrent lateral patellar instability after bracing, rehabilitation, or other nonsurgical treatment has not provided adequate stability. It can also be considered after selected high-risk first-time dislocations or when patellar maltracking remains severe. Surgeons assess trochlear shape, patellar height, limb alignment, rotational anatomy, and the tibial tubercle before deciding whether isolated ligament reconstruction is enough. Significant bony abnormalities can require an additional alignment or trochlear procedure.

How Is Medial Patellofemoral Ligament Reconstruction Performed?

The surgeon prepares a tendon graft, commonly an autograft or allograft, and creates fixation sites at the medial patella and the anatomic femoral attachment. The graft is passed between these points and secured with anchors, tunnels, screws, or another fixation method. Graft position and tension are checked through knee motion so the patella is stabilized without being pulled too tightly toward the inside. Arthroscopy or additional procedures can be performed at the same operation to treat cartilage injury or contributing alignment problems.

What Is Recovery Like After MPFL Reconstruction?

The knee is protected with a brace and crutches during early recovery according to the reconstruction and any associated procedures. Physical therapy focuses on swelling control, gradual range of motion, quadriceps activation, walking mechanics, and progressive strength. Running, jumping, cutting, and pivoting are delayed until strength, motion, and patellar control have recovered. Return to sport generally takes several months and is based on functional milestones rather than time alone.

What Are the Risks and Complications?

Possible complications include infection, blood clots, stiffness, persistent pain, recurrent instability, and graft failure. Incorrect femoral tunnel placement or excessive graft tension can overconstrain the patella and increase medial pressure or limit knee motion. Patellar tunnels can weaken the kneecap and rarely contribute to patellar fracture. Some patients require additional surgery for stiffness, recurrent dislocation, hardware symptoms, cartilage damage, or uncorrected bony malalignment.

Frequently Asked Questions About MPFL Reconstruction

What does the medial patellofemoral ligament do?

The ligament helps prevent the patella from shifting or dislocating toward the outside of the knee, particularly during the early part of knee flexion.

Is MPFL reconstruction used after every kneecap dislocation?

No. First-time dislocations are commonly treated nonsurgically unless specific high-risk injuries or anatomical factors justify surgery. Reconstruction is more commonly used for recurrent instability.

What type of graft is used for MPFL reconstruction?

Surgeons commonly use a tendon autograft or allograft. Hamstring-type grafts are frequently selected, but graft choice varies with the patient and technique.

Can the kneecap dislocate again after MPFL reconstruction?

Yes. Recurrent instability is possible, particularly when graft failure, new trauma, technical factors, or significant uncorrected bony abnormalities are present.

References

Unstable Kneecap (Patellar Instability). OrthoInfo, American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/unstable-kneecap. Date Accessed August 13, 2026.

Patellar Instability. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/patellar-instability. Date Accessed August 13, 2026.

MPFL reconstruction: indications and results. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC7944812/. Date Accessed August 13, 2026.

Rehabilitation Following Medial Patellofemoral Ligament Reconstruction for Patellar Instability. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC5455199/. Date Accessed August 13, 2026.

A Systematic Review of Complications and Failures Associated with Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation. PubMed. https://pubmed.ncbi.nlm.nih.gov/22679297/. Date Accessed August 13, 2026.