Medial PatelloFemoral Ligament (MPFL) Reconstruction is an arthroscopically assisted, minimally invasive procedure, allowing for smaller incisions, less scarring and less post-operative pain with a faster rehabilitation compared with open surgery.

The surgery involves taking a graft from one of your hamstring tendons (gracilis tendon) and reattaching it to the inside of your knee cap (patella) and thigh bone (femur), to prevent the knee cap from dislocating to the outside of the knee again. Satisfaction rates after this surgery are high, and in the majority of people, solves their problem.

DAY OF SURGERY


You will be admitted on the day of surgery. You will be provided with the admission time and fasting details.

POST OPERATIVE CARE


Inpatient Stay
Most patients are discharged from hospital after an overnight stay. During your inpatient stay, the focus will be on keeping you comfortable, and commencing the first phases of rehabilitation. You will be seen post-operatively by your knee surgeon, the physiotherapists and nursing staff who all have a role in your care. We also place your knee in a brace for you at the completion of surgery, and the staff at the hospital will help to show you how to take it one and off as needed.

First 2 weeks
Brace
We will place your leg in a straight knee brace for you at the completion of your surgery. This brace is to be used at all times when up and about and walking for at least the first two weeks, and when sleeping. The brace needs to be worn when walking until you have regained good leg control and you feel stable - this will take between 2 and 6 weeks after surgery.

Crutches
Crutches are used when mobilising for a variable amount of time, often up to a couple of weeks or so. You can progressively increase the amount of weight you put through your operated leg as your comfort allows.

Range of motion
Stiffness does not tend to be a problem after this procedure, although it is helpful to start bending and straightening your knee after surgery. 3-5 times per day, you should do some light bending and straightening exercises.

Ice, elevation and compression
Your knee will be swollen after surgery and it is helpful to work at reducing this swelling. Aim to elevate your knee (above the level of your heart) frequently, and ice your knee every 2 hours in the initial period after surgery. You will have a compression bandage placed on your knee after surgery to help with swelling – this can be removed as necessary and for icing.

Follow-up
You will be reviewed in the rooms approximately 2 weeks after surgery. If you are unsure of your follow-up appointment, please call the clinic.

2-6 weeks
Continue to ice the knee regularly and elevate to help with residual swelling. Aim to re-establish a normal walking cycle. Physiotherapy can help during this phase to re-establish your muscle and joint function. Once your knee feels stable you can start to walk short distances without the brace, although there is no rush to do this and you should take your time to feel steady on your feet. Once the incisions have healed, you can commence some light swimming with a pool buoy between your legs. When you have good range of movement and your comfort allows, some gentle exercise bike riding can be commenced - this is often after 4 weeks or so.

6-12 weeks
It is recommended that you see a Physiotherapist who has experience in sports rehabilitation. During this phase you will work on building your thigh muscle strength, joint stability and confidence.

3 months plus
Riding and exercises will start to get harder at this time. Aim to start running at the 3 month mark, although the timing of this is very variable between individuals.

RETURN TO PLAY


Each sport is specific, and we will discuss your expected return to play prior to surgery. In general, return to full participation in pivoting type sports is anticipated approximately 6 months.

WOUND CARE


If the dressings remain dry there is no need to replace them and at the two week post-op check they will be removed and the wounds assessed. However, if a dressing does become wet or need replacing, simply remove it and replace with a new one.

PAIN RELIEF


In general, regular paracetamol and an anti-inflammatory (if tolerated) are the mainstays of pain relief. You will be given some stronger medications which can be helpful in the early post-operative phases, but these can be phased out as your comfort level increases.

DRIVING


You can return to driving when you are walking comfortably, unaided and have regained good control of your knee. In general, for a right leg (and an automatic car), this is between 3-4 weeks. If you have had a left knee reconstruction, this might be earlier.

RETURN TO WORK


No matter what you do for work it is advisable to take at least the first two weeks after surgery off so you can rest, elevate your leg and get comfortable. It is feasible to return to lighter duties after the two-week post-op check, although it is important to remember that with more mobilisation and less elevation you will get more swelling and then more discomfort. For those doing heavy work, return to work can be between 6 and 12 weeks depending on the intensity.

PROBLEMS


Donor site pain
Experiencing some discomfort in the back of the thigh where the tendon was harvested is common and will generally settle in the first 2-4 weeks.

Infection
Superficial infection is not very common but can happen. It usually presents as redness and increased pain around the wound, and generally resolves with a short course of antibiotics.

Deep infection
Deep knee infection is rare. However, if it does happen you will need admission to hospital, with washing out of the knee and high dose intravenous antibiotics commenced immediately. It usually presents between 5-10 days post-operatively, with increased pain (rather than the general improvement in pain levels), increased swelling and marked decrease in your range of movement.

If you are concerned about an infection, please contact the rooms as soon as possible. During business hours the best point of contact is 08 9212 4200. After hours, please contact the hospital where you had your surgery, and ask them to get in touch with your surgeon. Failing this, present to your local emergency department.

Numbness
Some temporary numbness can be experienced in the days following surgery. As mentioned previously, our surgeons perform this surgery with small incisions, and long-lasting numbness is very rare.

Foot and Ankle Swelling
This is normal to an extent, and generally reflects the effects of gravity on the swelling around your knee. If you get excessive foot and ankle swelling, remove your compression bandage, elevate your leg above your body and ice your knee.

Re-Injury
This is unusual in the early post-operative period. However, accidents happen, and if you are concerned your knee should be checked. Please contact the rooms if you have any concerns and we can organise a review.

Perth Orthopaedic & Sports Medicine Centre

31 Outram Street
West Perth WA 6005

9.00am – 5.00pm Monday to Friday

NEW FAX  +61 8 9212 4264

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