MPFL Reconstruction for Recurrent Patellar Dislocation in Ludhiana
Individualised treatment of kneecap instability by Dr. Tanveer Bhutani at Eva Hospital, Ludhiana
The kneecap may dislocate during a twisting injury, sports activity, fall or direct impact. While many first-time patellar dislocations can be treated without surgery, repeated dislocations or persistent instability can make the knee unreliable and may damage the cartilage beneath the kneecap.The medial patellofemoral ligament — or MPFL — is an important restraint that helps prevent the kneecap from moving excessively toward the outside of the knee. MPFL reconstruction may be considered for selected patients with recurrent patellar instability, after detailed assessment of the ligament, cartilage, knee alignment, trochlear shape and other anatomical risk factors.At Eva Hospital, Dr. Tanveer Bhutani individualises treatment rather than recommending one standard operation for every dislocating kneecap.
Understanding the Kneecap
The patella (kneecap) normally moves within the trochlear groove at the lower end of the femur. The quadriceps muscle and tendon, patellar tendon, trochlear groove, limb alignment and medial soft tissues collectively guide and stabilise it.
- A dislocation usually occurs toward the outside of the knee
- A subluxation is a partial shift that may reduce without complete dislocation
- Patellar instability describes a tendency for repeated excessive movement, subluxation or dislocation
What Is the MPFL?
The medial patellofemoral ligament connects the inner aspect of the kneecap to the inner side of the femur. It is an important restraint against outward displacement of the patella, especially during the early part of knee bending.
The MPFL is commonly stretched or torn during a lateral patellar dislocation. In some patients, it heals sufficiently with rehabilitation. In others — particularly those with recurrent instability — it may no longer provide adequate restraint.
How Does a Patellar Dislocation Occur?
Injury Mechanisms
- Sudden twisting with the foot planted
- Change of direction
- Landing from a jump
- Direct blow to the inner side of the kneecap
- Football, basketball, badminton or kabaddi
- Running or dancing
- Fall or road traffic injury
Anatomical Predisposition
- Shallow or abnormal trochlear groove (trochlear dysplasia)
- High-riding kneecap (patella alta)
- Increased lateral position of the tibial tubercle
- Excessive patellar tilt
- Rotational alignment abnormalities
- Knock-knee alignment (genu valgum)
- Generalised ligamentous laxity
- Weakness or poor neuromuscular control
- Previous dislocation, or skeletal immaturity
Symptoms
Sudden Kneecap Displacement
Visible Deformity (Acute)
Pain Around the Kneecap
Rapid Swelling
Inner Kneecap Tenderness
Feeling the Patella May Move Out
Repeated Subluxation
Recurrent Dislocation
Apprehension During Bending
Difficulty With Stairs
Difficulty Running / Changing Direction
Clicking or Catching
Circulation and nerve examination
X-rays
Swelling and tenderness assessment
Evaluation for fracture
MRI where indicated
Temporary brace or support
Crutches
Orthopaedic follow-up
First-Time vs Recurrent Dislocation
First-Time Patellar Dislocation
Many first-time dislocations can be treated without immediate reconstruction, provided:
- The kneecap has been reduced
- No major displaced cartilage or bone fragment requires treatment
- The knee is otherwise stable
- There is no compelling high-risk anatomical or clinical reason for early surgery
Recurrent Dislocation
Repeated dislocation or persistent subluxation may indicate that the medial stabilising structures no longer provide sufficient control. It can lead to:
- Fear of movement
- Repeated falls or giving way
- Sporting restriction
- Cartilage injury or loose bodies
- Persistent swelling
- Increasing loss of confidence
- Progressive patellofemoral symptoms
Diagnosis
History of Dislocation / Instability
Clinical Examination
X-rays
MRI
Alignment / Rotational Imaging (When Indicated)
Individual Treatment Plan
Clinical Examination
Patellar apprehension, direction and degree of patellar movement, tracking, J-sign, knee alignment, generalised laxity, quadriceps and hip control, range of movement, ACL and other ligament stability, meniscus/cartilage symptoms.
X-rays
Patellar position, trochlear shape, patellar tilt, patella alta, fracture, osteochondral fragment, joint alignment.
MRI
MPFL injury pattern, cartilage damage, bone bruising, osteochondral fracture, loose body, trochlear anatomy, other ligament or meniscus injury.
CT / Alignment Imaging
May be considered when assessment of rotational alignment, tibial-tubercle position or bony anatomy is required.
Can Patellar Instability Be Treated Without Surgery?
Physiotherapy May Include
- Swelling control and restoration of range of movement
- Quadriceps strengthening
- Hip-abductor and external-rotator strengthening
- Core conditioning and balance
- Neuromuscular control and patellar tracking exercises
- Landing and movement retraining
- Gradual return to sport
Bracing and Taping
A brace or taping may provide short-term support in selected cases but should not replace muscle restoration and movement retraining.
When May Surgery Be Recommended?
MPFL reconstruction may be considered when there is:
Recurrent lateral patellar dislocation
Repeated symptomatic subluxation
Persistent objective instability
Failure of appropriate rehabilitation
Significant apprehension restricting normal activity
Instability affecting sport, work or daily life
A suitable anatomical pattern for isolated reconstruction
Associated pathology requiring surgical treatment
When Is Isolated MPFL Reconstruction Sufficient?
Recurrent instability is the primary complaint
The MPFL is functionally insufficient
Bony alignment does not require separate correction
Trochlear or patellar-height abnormalities are not judged to require another operation
Cartilage damage does not require a different treatment strategy
Skeletal maturity and anatomy permit the planned reconstruction
Associated Procedures
Osteochondral-Fragment Treatment
A loose or displaced cartilage-and-bone fragment may need fixation or removal, depending on size, location and viability.
Tibial Tubercle Osteotomy
The tibial tubercle may be repositioned in selected patients to address abnormal tracking, alignment, patellar height or joint loading.
Trochleoplasty
Reshaping of the trochlear groove is reserved for selected severe cases — not routinely required for every patient with trochlear dysplasia.
Cartilage Treatment
Cartilage injury may be treated during the same surgery when clinically appropriate.
Lateral-Sided Procedures
Used only for selected indications — not performed automatically for instability.
Skeletally Immature Patients
Surgical planning must protect the growth plates; techniques may differ in children and adolescents who have not completed growth.
What Is MPFL Reconstruction?
MPFL reconstruction recreates the function of the damaged medial patellofemoral ligament using a tendon graft. The graft is attached to the kneecap and femur at anatomically planned locations, with the aim of providing stability while allowing normal patellar movement.
Goals:
- Reduce recurrent lateral instability
- Restore confidence
- Improve functional stability
- Protect against repeated dislocation
- Avoid excessive constraint of the kneecap
- Support return to routine and sporting activity
Graft Options
Gracilis Tendon
Semitendinosus Tendon
Quadriceps Tendon
Other Autograft Options
Allograft (Selected Situations)
Fixation Techniques
Fixation may involve suture anchors, patellar sockets or tunnels, soft-tissue fixation, femoral socket or tunnel fixation, and implant-free or limited-implant techniques in selected cases.
What Happens During Surgery?
Anaesthesia & Examination
Arthroscopic Assessment (Where Indicated)
Loose Body / Cartilage Treatment
Graft Preparation
Anatomical Fixation
Tracking & Tension Check
Closure & Rehab Plan
Not every patient requires arthroscopy or an associated bony procedure.
Hospital Stay and Pain Management
Anaesthesia evaluation
Multimodal pain management
Swelling control
Early physiotherapy
Brace where prescribed
Crutch training
Discharge after safe mobilisation
Rehabilitation After MPFL Reconstruction
Protection & Swelling Control
Protect the reconstruction, control pain and swelling, restore quadriceps activation, begin safe knee movement, brace/crutches as advised, avoid falls and twisting.
Restore Movement & Walking
Progressive range of movement, gradual weight-bearing, patellar mobility where appropriate, normal walking pattern, controlled closed-chain strengthening.
Strength & Control
Quadriceps, hip and core strengthening, balance, single-leg control, stationary cycling, progressive functional exercises.
Running & Agility
Running only after strength, control and swelling criteria are met; progressive jumping/landing; directional-change drills; sport-specific movement; confidence assessment.
Return to Sport
Functional testing, strength comparison, movement-quality assessment, no significant pain/swelling, no recurrent apprehension, surgeon and physio clearance.
Individualised Adjustments
Protocols differ if MPFL reconstruction is combined with tibial tubercle osteotomy, cartilage fixation, osteochondral surgery, trochleoplasty, or another ligament procedure.
Approximate Recovery Milestones
| Milestone | Approximate Expectation |
|---|---|
| Crutches and Brace | Duration depends on the surgical procedure performed and the rehabilitation protocol prescribed by the surgeon. |
| Desk-Based Work | Many patients are able to return within a few weeks, depending on comfort, mobility, and job demands. |
| Comfortable Routine Walking | Usually achieved progressively during the early stages of rehabilitation as strength and confidence improve. |
| Driving | Can resume once safe vehicle control, reaction time, and knee function have been restored. |
| Cycling | Typically introduced during rehabilitation when adequate knee movement and control have been achieved. |
| Jogging | Commonly begins after several months, following satisfactory clinical assessment and functional clearance. |
| Sports Training | Often resumes around 6–9 months, depending on recovery progress and successful functional testing. |
| Full Pivoting Sport | Frequently permitted after 9 months or longer, once strength, stability, and sport-specific criteria are met. |
Expected Results
Most appropriately selected patients experience improved stability and fewer recurrent dislocation episodes after MPFL reconstruction. However, outcomes depend on correct identification of all contributing anatomical factors, accurate graft positioning, appropriate tensioning, associated cartilage damage and rehabilitation. Published reviews generally report low recurrence after isolated reconstruction, but results vary between studies and patient groups. A modern systematic review found recurrent instability ranging from 0% to approximately 11%, while complications varied considerably according to technique and study definition.
Risks and Complications
- Infection
- Blood clot
- Knee stiffness
- Loss of movement
- Persistent anterior knee pain
- Recurrent instability
- Graft stretching or failure
- Patellar fracture
- Implant irritation
- Numbness near an incision
- Overconstraint or excessive graft tension
- Abnormal patellar tracking
- Cartilage symptoms
- Need for further surgery
- Complications related to associated osteotomy or cartilage treatment
Why Might Surgery Fail?
Unrecognised bony risk factors
Incorrect diagnosis
Graft malposition
Excessive or insufficient graft tension
Significant patella alta
Severe trochlear dysplasia
Rotational malalignment
Reinjury
Inadequate rehabilitation
Generalised ligamentous laxity
Advanced cartilage damage
Premature return to sport
Successful treatment requires more than simply reconstructing one ligament.
Why Choose Dr. Tanveer Bhutani?
Recurrent patellar instability requires assessment of the entire patellofemoral joint — not only the torn MPFL. Dr. Tanveer Bhutani evaluates the patient’s dislocation history, patellar tracking, trochlear shape, patellar height, alignment, cartilage condition, skeletal maturity and sporting requirements before recommending treatment.
Clinical & Imaging Evaluation
A full patellofemoral assessment, not just an MRI report.
Nonsurgical Treatment First
Surgery is not the default for every dislocation.
Individualised Reconstruction
Assessment for associated bony or cartilage procedures when needed.
Structured Follow-Up
Physiotherapy, return-to-sport planning and long-term review.
Patient Journey
Consultation
Patellar Stability & Alignment Exam
X-rays & MRI
Physio or Surgical Discussion
Individualised Procedure
Protected Rehabilitation
Strength & Functional Testing
Return to Activity
About Your Surgeon
Dr. Tanveer Bhutani
Dr. Tanveer Bhutani treats patellofemoral instability, ligament injuries and complex sports trauma at Eva Hospital, Ludhiana, with an approach centred on individualised, evidence-based assessment rather than one standard operation for every patient.
Related Pages
Frequently Asked Questions
The MPFL is an important ligament on the inner side of the kneecap that helps prevent excessive outward movement.
It is commonly stretched or torn, but the exact injury location and severity vary.
No. Many first-time dislocations are initially treated with rehabilitation unless there is an associated fracture, loose body or another compelling indication.
Its principal indication is recurrent symptomatic lateral patellar instability.
Physiotherapy can improve strength and movement control and is effective for many patients, but it cannot correct every anatomical or structural cause of instability.
Subluxation is partial displacement; dislocation means the kneecap completely leaves the trochlear groove.
It is an abnormal or shallow shape of the groove in which the kneecap normally travels.
It means the kneecap sits higher than usual, which can delay its engagement within the trochlear groove during bending.
It is a procedure that repositions the attachment of the patellar tendon in selected patients to improve alignment, tracking or loading.
No. Additional bony procedures are used only when the patient’s anatomy and instability pattern justify them.
Common options include gracilis, semitendinosus or quadriceps tendon. Selection is individualised.
It may be used to evaluate or treat cartilage damage, loose bodies or other internal knee pathology when indicated.
Many patients receive a brace initially, but the duration depends on the procedure and rehabilitation plan.
Walking usually begins with protection and assistive support, progressing according to the reconstruction and any associated procedures.
Driving should resume only when the patient is no longer impaired by medication or a brace and can safely control the vehicle.
Many patients return within a few weeks, depending on pain, mobility, transport and the nature of their work.
Running is introduced only after adequate movement, strength, stability and functional control have returned.
Many patients return to sport after successful reconstruction and rehabilitation, but clearance is based on objective recovery rather than time alone.
Yes, although recurrent instability is relatively uncommon in appropriately selected and treated patients.
Not necessarily. The operation primarily treats instability. Pain from cartilage damage, overload or other patellofemoral conditions may persist.
Yes, but the technique must account for open growth plates and skeletal development.
Repeated episodes can cause fear, functional restriction and further cartilage or osteochondral injury.
Dealing With a Recurrently Unstable Kneecap?
Book an orthopaedic evaluation with Dr. Tanveer Bhutani at Eva Hospital, Ludhiana.