Patella luxation - MPFL reconstruction (postoperative program)
Patella or the knee cap is located directly in front of the knee joint and it is a part of it. It is connected to the quadriceps tendon at its proximal part and from its distal part the patellar tendon originates and descends towards the shin bone where it connects to the tuberositas tibiae. Together with these two tendons and the quadriceps muscle the patella forms the extensory mechanism of the knee joint. During knee enxtension the quadriceps tendon pulls the patella upwards and it slides at the distal part of the femur bone.
Patella is stabilized by a number of ligaments that keep her properly positioned and enable her to track straight up and down at the front of the knee without sliding medialy or lateraly. There are the medial and lateral retinaculums (retinaculum medialis et lateralis), tendon tissue originating from either the medial or lateral quadriceps muscle parts, ie. its tendon tissue. Their roles are to stabilize the patella and the knee joint capsule. The main passive stabilizer of the patella, whose role is also the stabilization of the patelo-femoral joint, is the medial patelo-femoral ligament (MPFL). This ligament keeps the patella in its place, along with the lateral patelo-femoral ligament, by not allowing it to slide inwards or outwards. When either of those ligaments, more commonly the MPFL, gets injured the patella can get dislocated or luxated. In case the MPFL is torn the patella slides lateraly, outwards and it does not slide upwards in the right position during extension. Commonly a patella luxation occurs after an acute MPFL injury, a partialy or completely ruptured MPFL, due to degenerative changes of the patella or knee capsule cartilage or bone tissue, upper leg muscle strenght deficits, medial part of the quaadriceps being too weak in comparison to the lateral part, etc. They are common in car accidents, direct blows or falling on the knee, but they can also occur in daily activities such as squatting, getting out of the car, walking and they can be repetitive, ie, the aptella gets chronically instable, which is in most cases caused by muscle weakness, genetic predisposition or a degenerative change in the bone or cartilage tissue (dysplasia of the patella femur or tibia).
Treatment of patellar luxation can be done conservatively or surgically (MPFL reconstruction). MPFL reconstruction is done surgically, with an arthroscopic approach, by stitching the ligament at the place where it was torn or doing a complete anatomical reconstruction which is the favored method today due to the fact that it is difficult to find the exact spot where the rupture occured, especially if it occured farther from the origin of the ligament on the femur. MPFL reconstruction can be done separately or combined with other surgical pricedures depending on the state of the knee and other possible damage in it. It can be done in combination with, eg. releasing of the LPFL (lateral patelo-femoral ligament), cartilage reconstruction or cleaning, ACL reconstruction, etc.
Rehabilitation post MPFL reconstruction has the same principles as the conservative therapy approach. Strenghtening of the medial quadriceps muscle, the hamstring and gluteus muscles, knee stability exercises, but the load progression is slower and the rehabilitation last longer in this case. Retaining knee range of motion, especially knee flexion, should be done carefully and patiently so the reconstructed MPFL would not get reinjured.
Prevention: timely and proper treatment of earlier knee injuries/damage, equal strenghtening of all upper leg muscles in order to prevent any muscle deficits, stretching of the lateral quadriceps region if it is a bit stronger because in that case it pulls the patella outwards and increases the risk of patella luxation, etc.
Umer Butt, MD, MRCS (UK), FRCS T&O (UK), Senior Consultant Orthopaedic Surgeon
Rehabilitation program author
Dr Butt is a full time Senior Consultant Orthopaedic Surgeon Specialist in Knee/Shoulder Sports Injury, Arthroscopy and Arthroplasty Circle Bath Hospital UK AO Clinic Centre for Orthopaedic, Trauma and Sports Injury KarachiGo to profile
- Program short URL: https://www.videoreha.com/11764
Program duration is 65 days. If you start today on 30.11.2020., the completion of the rehabilitation program will be on 03.02.2021.
Total price is US $40.00 or US $0.62 per program day