MEDIAL PATELLOFEMORAL LIGAMENT (MPFL) RECONSTRUCTION
Medial Patellofemoral Ligament reconstruction is also known as Kneecap Reconstruction Surgery. Replacing the kneecap can occur naturally by a doctor guiding the kneecap back in place. In addition it can occur spontaneously by straightening the leg, or by surgery when everything else fails.
If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.
Medial Patellofemoral Ligament (MPFL) Reconstruction
Knee Bones
A sharp blow to the knee or an unnatural twisting of the knee can lead to patellar (kneecap) dislocation. A kneecap dislocation can occur if the surrounding ligaments are weak or if an anatomical tendency exists. The most crucial step after a kneecap dislocation is to realign the kneecap to its correct position. This entails moving the patella into the trochlear groove. Sometimes requiring an emergency hospital visit, this frequently occurs spontaneously by simply straightening the leg.
The ligaments holding the kneecap in place may rip, and bits of the kneecap’s cartilage or the trochlear groove may come loose. Recurrent dislocations or subluxations (partial dislocations) of the patella can happen in the absence of appropriate treatment, which in some circumstances means Kneecap Reconstruction Surgery. Additionally, loose tendons, ligaments, and cartilage may buckle, snag, lock, or cause additional injury.
Symptoms and Diagnosis
Rapid, severe swelling and excruciating pain are signs of a kneecap dislocation. Up until the kneecap moves, this severe discomfort will last; after that, it will go away. As a result of the misaligned kneecap, further symptoms include the inability to move the knee, bruising, and deformity of the knee. A more thorough medical history and physical examination are needed if the kneecap dislocates and promptly pops back into place (relocates). Our doctors will do a thorough medical history and physical examination, while an X-ray and MRI will evaluate this injury to confirm the diagnosis and evaluate the Kneecap, cartilage, and other ligaments of the knee.
Kneecap Reconstruction Surgery Procedure
The Anesthesiologist will begin the first step in the procedure for Kneecap Reconstruction Surgery. He will use general anesthesia to put your child to sleep by injecting a drug into a vein. Repairing the Kneecap involves creating a new ligament to compensate for the damaged ligament. One of the thigh tendons (gracilis or semitendinosus) gets removed through a small incision on the anterior medial side of the tibia. A tendon about 20 cm long is removed and a new ligament is created.
A few more small incisions are then made in the front of the knee to reconstruct the ligaments from the anterior medial edge of the patella to the medial (medial) edge of the femur. Sutures or plastic screws, inserted into tiny drill holes, will hold the MPFL in place. The procedure may occur with one single incision, but it usually only requires three minor incisions, each ranging between 2 and 4 cm. The number of incisions also depends on the need for additional surgeries, such as a tibial tubercle osteotomy. In general, the Kneecap Reconstruction Surgery takes between 60 and 90 minutes.
QUESTIONS AND ANSWERS
Why do children undergo kneecap reconstruction surgery?
- Recurrent Dislocations: Children who experience recurrent patellar dislocations may require surgery to stabilize the kneecap and prevent further dislocations.
- Chronic Pain: Severe patellofemoral pain that doesn’t respond to non-surgical treatments, such as physical therapy or bracing, may lead to surgery.
- Structural Abnormalities: Structural issues, such as a shallow trochlear groove (the groove in the thigh bone where the kneecap moves), can necessitate surgery to correct and realign the patella.
- Maltracking: If the patella does not track properly within the groove, it can cause pain and instability. Doctors may recommend surgery to address this problem.
What is involved in kneecap reconstruction surgery for children?
- Surgical Techniques: There are different surgical techniques used, depending on the specific issue. Common procedures include lateral release, medial patellofemoral ligament (MPFL) reconstruction, tibial tubercle transfer (e.g., TTO or Fulkerson procedure), and osteotomies to address structural abnormalities.
- Anesthesia: The surgery is typically performed under general anesthesia, and sometimes with regional nerve blocks.
- Recovery: After surgery, children may need to use crutches and wear a knee brace to support and protect the knee. Physical therapy is a crucial component of recovery to regain strength and range of motion.
- Activity Restrictions: There are often restrictions on activities and sports for several months after surgery to allow the knee to heal.
What is the expected outcome after kneecap reconstruction surgery in children?
- Stability: The primary goal of the surgery is to restore stability to the kneecap and prevent recurrent dislocations.
- Pain Relief: The surgery aims to alleviate chronic patellofemoral pain, allowing children to return to their normal activities with less discomfort.
- Improved Function: In many cases, the surgery results in improved knee function and range of motion.
- Long-Term Benefits: Successful surgery can have long-term benefits, reducing the risk of future knee issues.
The specific details of kneecap reconstruction surgery can vary based on the child’s age, the severity of the condition, and the surgical approach chosen by the orthopedic surgeon. Parents and caregivers should discuss the surgery in detail with the healthcare provider, ask any specific questions they may have, and ensure that the child receives the appropriate post-operative care, including physical therapy and follow-up appointments for the best possible outcome.
It’s important to take our children to doctors who specialize in children. The doctors and surgeons at Medical City Children’s Orthopedics and Spine Specialists are experts in children and their knees.
Postoperative Recovery
Doctors refer to this surgery as day surgery. When your child wakes up, the knee he or she will find the knee bandaged, and after a couple of hours, the child can go home. A physical therapist will contact the parents and will monitor your child and show him or her how to use crutches. Your child can put his or her weight on the whole leg. Children need crutches for only about 3 to 5 days after surgery and primarily use them to keep the knee from collapsing while the soft tissue heals. The primary goals of early rehabilitation include reducing swelling, compressing the knee, lifting the leg, and gently tightening the muscle to minimize muscle wasting. Patients usually complete the physical therapy in a single day.
What Should I Expect After Kneecap Reconstruction Surgery?
It is normal to have some discomfort following Kneecap Reconstruction Surgery. During the first five days, anti-inflammatory drugs will keep any discomfort from occurring. Additionally, your child will receive additional painkillers that your child can use as advised by your doctor. Generally speaking, pain is not severe right away after Kneecap Reconstruction Surgery since local anesthesia is given at the time of the procedure to significantly lessen major discomfort during the early postoperative period. Ice your child’s knee often, 20 minutes every hour during the day, for the first several days as this will help to minimize discomfort and inflammation.
Outcomes for Kneecap Reconstruction Surgery
After Kneecap Reconstruction Surgery, the majority of patients may resume their usual lives, including their sports. Most experts estimate that there is a 2-4% possibility of experiencing more dislocations.
Potential Risks Associated with Kneecap Reconstruction Surgery
Infection
An infection following Kneecap Reconstruction Surgery carries a 0.5% chance. Although exceedingly unlikely, it is nevertheless possible for an infection to happen. For the purpose of lowering the risk of infection, our surgeon will prescribe antibiotics before surgery. An infection of the knee joint or a mild infection of the incisions may occur. The doctor will prescribe Antibiotics when this occurs. The need for hospitalization and intravenous antibiotics becomes necessary if the infection affects deeper structures and is significant. In the unlikely event that this ever occurs and it never has occurred in our practice, an arthroscopic procedure on the knee will take place to remove the infection if it affects the knee joint.
Blood clots
“Deep Venous Thrombosis” – Depending on the patient, there is a 2-10% chance of getting a blood clot in a vein in your child’s leg. These blood clots occur rarely and make their way to the patient’s lungs. Pulmonary embolism refers to the medical word for this condition and it is extremely unlikely to occur. Following your child’s operation, you should call your surgeon right away if your child experiences any calf discomfort or soreness. The calf will undergo an ultrasound scan to check for blood clots. If they exist, the doctor will prescribe medications to stop these blood clots from growing bigger. It is crucial to let your surgeon know if you have any familial risk factors for blood clot development in order to reduce the likelihood of a blood clot.
Recurrent dislocation
The chance of the Kneecap Dislocating again after medial patellofemoral ligament repair occurs about 2-4% of the time. If your child has previously had two dislocations, this percentage rises to nearly 50%, and if your child experiences recurring instability, it even goes higher.
Numbness around the surgical incisions – Numbness in the vicinity of surgical incisions is typical. These little patches of numbness will go away after a period of time and don’t harm patients. Sometimes stretching of the saphenous nerve where the gracilis tendon gets harvested from might result in a persistent patch of numbness at the top part of the tibia on its outside.
Stiffness
Following Kneecap Reconstruction Surgery, many patients feel that their knee feels slightly stiff. In the event that this does take place, your child could need a second procedure in which the kneecap is either surgically moved or scar tissue gets removed from the knee joint inside. Prior to surgery, it’s crucial that patients have a decent range of motion. After the surgery, we recommend that the patient conduct frequent stretching exercises to avoid stiffness. The most crucial need is that patients take part in the postoperative rehabilitation program under the supervision of a physiotherapist.
Patellar fracture
There are rare reports of children breaking their kneecap after surgery. This is because the doctor will drill a hole across the patella, making it more delicate, in order to attach the graft.
Hardware-related complications
Due to the necessity of using metal clips and screws to secure the new medial patellofemoral ligament graft in place, these devices may protrude and irritate the patella or the inner femoral border directly above the knee joint. If this happens, the doctor will remove the screws after the graft heals.
Ongoing swelling or pain
It is typical for children who have had patellar dislocations to incur damage to the patellar or femoral cartilage. Doctors refer to this as “post-traumatic osteoarthritis”. The loss of cartilage is frequently irreparable, but our surgeon will check the knee arthroscopically and fix any unstable regions. Following surgery for this cartilage injury, patients will experience discomfort or swelling.
Kneecap Reconstruction Surgery does not solve knee swelling. In general, knee swelling generally improves within about three months after surgery. Subsequent persistent swelling can occur due to chronic damage to the cartilage, which can progress to osteoarthritis later in life. A very tight graft can cause accelerated arthritis in the knee joint.
Post-Operative
Finally, In order to restore knee joint function, our doctors will recommend a stepwise rehabilitation program. This program includes immobilization of the joint at first, followed by physical therapy, strengthening exercises, and range-of-motion exercises. Depending on the patient, a return to normal activities might happen as soon as 8 to 12 weeks after Kneecap Reconstruction Surgery. Athletes who compete in contact sports may need a longer period of recovery.
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Footnote:
National Center for Biotechnical Information: Kneecap Reconstruction
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