Patellofemoral Reconstruction

What is patellofemoral reconstruction?

Patellofemoral reconstruction is a surgical procedure for stabilising the patellofemoral joint, which is where the kneecap (patella) contacts the thighbone (femur). This joint is stabilised by the lateral patellofemoral ligament (LPFL) on the outside of your knee and the medial patellofemoral ligament (MPFL) on the inside of your knee. The MPFL plays a key role in keeping the kneecap in place and preventing patella dislocation.

If the patella is dislocated, the MPFL is often stretched or even ruptured. If this results in an unstable kneecap, the ligament may be surgically ‘tightened’. When the ligament is torn, it cannot usually be repaired by stitching the ends together. Restoring stability typically involves reconstructing the ligament using a graft taken from another part of your body. Grafts are usually made from tendons (eg patella tendon, quadriceps tendon).

How does patellofemoral reconstruction work?

Patellofemoral reconstructionis performed under a general anaesthetic or regional anaesthetic (spinal). There are two parts to the procedure: harvesting the graft and using the graft to reconstruct the ligament.

To harvest the graft, your surgeon makes an incision over the graft site (usually over your knee) and cuts through tissues to reach the tendon. The required section of tendon is removed.

The reconstruction is typically done using arthroscopy. Your surgeon makes an incision into your knee joint and inserts the tiny camera of the arthroscope. Images are transmitted onto a large screen so your surgeon can clearly see the inside of your joint. One or two other incisions are made to allow a tiny surgical drill into the joint. This is used to make small tunnels through the patella and through the femur. The graft is pulled through the tunnels and anchored to the bone with screws.

The incisions are then taped or sutured closed. A wound dressing will be placed and your knee will be bandaged.

What to expect after patellofemoral reconstruction

It’s common to have some swelling of your knee, shin and ankle. Try and keep your leg elevated as much as possible to reduce swelling. Pain should be minimal (due to local anaesthesia), but you be given pain medication as needed.

Although you may be able to bear weight on your leg straight after surgery, before you go home, your therapist will teach you how to walk safely with a knee brace (and crutches if needed). You will also be given some simple exercises. These exercises are the start of your post-op rehabilitation program.

Initially physiotherapy will concentrate on keeping your knee flexible. Once initial healing is complete, strength exercises will be incorporated into your program. Your physiotherapist will adjust your program as needed.

It takes 6–9 months for full recovery, but you should be able to return to work after 3–4 weeks.