Bilateral MPFL reconstruction for patellar instability

MPFL patient

John discusses his experiences with MPFL reconstruction on both knees....

The onset of my problems, aged 16

Having played a lot of football and tennis aged ten and onwards, the problems with my knees first began to surface aged 16 whilst playing football at school. As a friend tackled me from behind I felt for the first time the ‘popping’ sensation that I was yet to become familiar with, this time in my right knee, and followed by extensive swelling and pain.

I continued to participate in tennis and football unaware of the true problem. However as the ‘popping’ sensation continued to occur, now in both knees, I was forced to give up both due to the swelling and pain.

Arthroscopy aged 19

Three years later, aged nineteen, I had an investigative arthroscopy on both knees by a local knee specialist hoping to find the cause of my problems. However it only resulted in the repair of mild cartilage damage leaving me none the wiser as to what the underlying issue was.

I was then recommended by a family friend to see a specialist who had helped with her knees, who almost immediately found the problem. Having found my femoral groove on both sides and lack of groove in the patella caused instability and therefore dislocation, which was the ‘popping’ sensation that I had felt for so long. I was then referred on to Professor Adrian Wilson as he is more of a specialist in this area and, having undergone more scans, he found that my patella was also sitting too high and offered me two options for surgery:

  • the smaller procedure - an MPFL reconstruction
  • the larger procedure - being both the MPFL reconstruction and a tibial tuberosity osteotomy to bring the knee cap down into place

Having now had two or three dislocations even whilst not playing sport we decided that surgery was necessary and I opted to just have the MPFL reconstruction, as Professor Wilson believed this would largely solve my issue with the dislocation of the patella.

Having had many dislocations by this point the damage to the cartilage on the back of the patellae was significant. I was therefore advised by Professor Wilson to refrain from any physical activity that would put stress on my knees even after the surgery and to even consider jobs that wouldn’t require me to be on my feet for a substantial amount of time. Consequently, I didn’t expect to feel much of a change after surgery as returning to sport was off the cards and my dislocations from day to day activities were minimal. The aim was to make the knee more stable and keep damage to a minimum to keep my knees going for as long as possible as I’m only twenty four at this time. We decided to proceed with my right knee first as that was the one with the most cartilage damage.

MPFL Reconstruction right knee

Having read a few horror stories online about how some people’s MPFL reconstructions had left them extremely uncomfortable, I approached the surgery with caution and at some points wondered whether I’d made the right decision to go down this route. However my apprehension was unwarranted as the whole procedure was rather straightforward. After resting in hospital for the night I was back on my feet the next day without needing crutches and experiencing minimal pain. I didn’t feel the need for painkillers during the day and only took a couple before bed to make it more comfortable in the event that I rested on the more tender areas where the incisions had been made.

I rested well for the first week and used a GameReady ice/compression machine, which I felt helped a lot with the swelling and overall recovery post op. It was only ten days until I was back driving and after a couple of weeks the knee felt reasonably back to normal again without feeling the need to be too careful on it.

Some months later....

MPFL reconstruction left knee

I am now six months post op on my right knee and even had a week’s skiing holiday three months after surgery with no problems at all. The MPFL reconstruction was also completed on my left knee seven weeks ago with a similar recovery thus far. I am continuing to work on the strength in my quadriceps using physiotherapy exercises and a cross trainer/exercise bike. As I previously mentioned the majority of my dislocations happened whilst playing sport and my inability to play sport even post op due to my cartilage damage has made it difficult to really see the change my MPFL reconstruction has had. Although both knees do feel very stable and I now feel more confident on them with the reduced likelihood of dislocation, therefore I would say the surgery has certainly been a success.

The main reason I was compelled to write about my experience is so anyone thinking of having an MPFL reconstruction can see it’s really not something to be too apprehensive about. Having read the horror stories pre op it would have done me a lot of good to read more positive post op diaries and realise the surgery/recovery isn’t too bad at all. Everyone’s recovery will inevitably be different but the overall experience certainly isn’t something to be too worried about.

adrian wilson

Adrian Wilson

Surgeon's perspective -

"This young man of 24 came to see me at the beginning of 2016 with bilateral unstable patellae and pain.

"He is a student of architecture. he has had problems for some time. At age 16 he had basic arthroscopic surgery done locally and did not get a huge amount of benefit from this, so he had to avoid physical activity and was really struggling with bending and squatting by the time he got to me.

"He is very typical for this problem with hypermobile joints and evidence of abnormal tracking of the patella and a high patella. The MRI scan is also fairly specific retropatellar damage due to the instability that was there.

"I recommended tidying up the retropatellar damage again but also stabilising the knees with MPFL reconstructions.

"I did do some further investigations to make sure there was not a rotational element - and there wasn't - so we could go for the relatively straightforward procedure of MPFL reconstruction.

"He did very well with the right side, but he did remarkably well with the left side. 

"I need to mention that before the operation on the left knee he was stable at 60 degrees flexion and unstable at 30 degrees flexion.  Based on discussions with patellar surgeon Philip Schoettle I believe these patients do well with isolated MPFL - but if they are unstable at 60 degrees flexion then they need a trochleoplasty procedure as well.

"We started with the right side and he did well. Then three weeks ago he underwent the left. This procedure involves taking hamstring tendon and taking the tails and making tiny drill holes in the side of the patella on the inside - then feeding these tails in and locking them in place with small screws. The loop, which is then exiting out the side of the kneecap, is taken down and pulled into a small tunnel at the correct insertion point for the ligament on the femur - hence the name  medial or inner patello- (kneecap) femoral (thigh) ligament (MPFL) reconstruction.

"You can see just how well people can do following this surgery. He has had no pain to speak of, and he got off his crutches on day 1 - he tells me he never really used crutches. He came in with a normal gait and had virtually full range of motion. So really very impressive."

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