Surgery: Patellar Dislocation

MPFL reconstruction for recurrent patellar dislocation: surgical technique, detailed postoperative course and return to sport. Dr. Priano, Milan.

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Medial patellofemoral ligament reconstruction for patellar instability

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Surgical Techniques

Medial Patellofemoral Ligament Reconstruction (MPFL)

Procedure to reconstruct the main medial stabilizer of the patella using a tendon autograft (gracilis or semitendinosus). The new ligament is fixed to the patella and femur at correct anatomical points.

Indication

Recurrent patellar dislocations (2 or more episodes), first episode with associated osteochondral lesion, persistent patellar instability despite rehabilitation.

Recovery

Hinged brace for 6 weeks. Intensive physical therapy for 4-6 months. Return to sport at 6-9 months.

Tibial Tuberosity Transfer (TTT)

Procedure to move the patellar tendon insertion on the tibia to correct an increased Q angle or patella alta. Can be combined with MPFL reconstruction.

Indication

Significant malalignment with increased Q angle, patella alta, complex cases with multiple predisposing anatomical factors.

Recovery

Protected weight bearing for 6-8 weeks. Extended physical therapy. Return to sport at 9-12 months.

Trochleoplasty

Reshaping of the femoral trochlea to create a deeper groove that stably accommodates the patella. Reserved for selected cases with severe trochlear dysplasia.

Indication

Severe trochlear dysplasia (Dejour type B, C or D) with flat or convex trochlea.

Recovery

Prolonged non-weight bearing period. Careful rehabilitation. Return to sport at 12 months.

Postoperative Overview

The surgical approach to recurrent patellar dislocation is personalized based on each patient's predisposing anatomical factors. MPFL reconstruction alone is sufficient in most cases; bony procedures are added only when necessary. Success depends critically on postoperative rehabilitation and VMO strengthening.

Detailed Recovery Timeline

Note: The timeline below is a general baseline. The actual postoperative course varies depending on the specific surgical technique chosen (see procedures above).

1 night hospitalization. Arthroscopy-assisted or mini-open surgery. Discharge with hinged brace locked in extension.

Weeks 1-2: Brace locked in extension for walking. Ice, rest with elevated leg. Immediate start of isometric quad exercises and passive patellar mobilization. Weeks 2-6: Progressive brace unlocking (20° per week up to 90°). Progressive weight bearing with crutches.

Weeks 6-8: Brace removal. Full weight bearing. Intensive physical therapy: VMO strengthening, proprioception, neuromuscular control. Full ROM recovery by week 8.

Months 2-4: Progressive muscle strengthening. Closed kinetic chain exercises (squat, leg press). Cycling, swimming. Light treadmill jogging at end of month 3 if good control.

Return to Sport

Months 4-6: Running, sport-specific exercises. Months 6-9: Gradual return to sport with protection (knee brace). Full return to competitive sport requires 9 months for isolated MPFL, 12 months if bony procedures combined.

Follow-up Schedule

Follow-ups at 2 weeks, 6 weeks, 3 months, 6 months, 1 year. Control MRI at 6 months to assess neoligament integration. Functional assessment before return to sport.

Possible Complications

Possible: stiffness (prevented by early physical therapy), recurrence of instability (5-10% with correct technique), residual anterior pain, hardware irritation (rare, removal if needed).

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