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The hidden hero of the knee: How repairing the MPFL can save you from multiple dislocations?
Knee health is vital for everyone who enjoys sports and staying active. However, the structure of the knee is complex, and each ligament within it plays a unique role. Especially the medial patellar ligament (MPFL) located on the inside of the knee, its stabilizing function is often overlooked, but it is the key to preventing knee dislocation.
Anatomy of MPFL
The medial patellar ligament (MPFL) is an important ligament located on the medial side of the knee. It originates from the superior medial side of the patella and inserts into the space between the medial epicondyle of the femur and the adductor tubercle. This ligament is shaped like a trapezoid and is responsible for stabilizing the patella and preventing it from shifting outward.
The MPFL is responsible for maintaining 50% to 80% of patellar stability, especially in the initial 20-30 degrees of knee flexion.
Function of MPFL
The main function of the MPFL is to maintain the stability of the patella and prevent it from dislocating outward. The stability of this ligament, in addition to relying on its own structure, is also assisted by two other ligaments: the medial patellotibial ligament (MPTL) and the medial patellomenilunar ligament (MPML). These ligaments work together to maintain the stability of the knee joint, allowing people to move freely without fear of knee injury.
Clinical significance
The MPFL is the primary stabilizer that prevents the patella from dislocating outward, providing approximately 50% to 60% of the restraining force. When the knee performs non-contact twisting movements, the MPFL is susceptible to injury, leading to an increased risk of patellar dislocation. Normally, the patella is most likely to dislocate outward in the early stages of flexion, that is, 20 to 30 degrees, because the contraction of the quadriceps muscle at this time pulls the patella outward.
Untreated MPFL injuries may heal on their own, but may be left in a loose or lengthened state, making the patella more likely to dislocate again in the future.
Injury and treatment
Although MPFL injuries are relatively rare, they occur primarily among athletes. When the patella dislocates outward, according to statistics, the MPFL will break 90% of the time. When the patella dislocates, the soft tissue layer in contact with the patella is damaged, resulting in malflexion. If left untreated, it may lead to more serious joint problems, including patellar osteoarthritis.
Non-surgical treatment
For non-surgical treatment of MPFL, it is important to ensure that there is no loose soft tissue, cartilage or bone within the knee joint. Initially, the patient will need to have the knee immobilized to promote healing of the ligaments and will often undergo physical therapy with functional rehabilitative and exercise training targeting muscles such as the glutes and quadriceps to strengthen the muscles around the knee joint.
Surgical treatment
For patients with significant damage, surgical treatment may be necessary. During the procedure, the patient receives local anesthesia and a nerve block, and may also require IV sedation. During the surgery, the surgeon typically replaces the damaged MPFL with the patient's hamstring or an autografted ligament from a cadaver, and uses an arthroscopic view of the inside of the knee to perform minimally invasive surgery.
According to research, the success rate of MPFL surgery is as high as 95%. However, in some cases complications may occur, such as fractures, infections, or blood clots. After surgery, patients are asked to avoid weight loading for the first few weeks and begin phasing into physical therapy. During the rehabilitation process, if the patient is an athlete, doctors and physical therapists need to approve the patient to return to sports.
Repair and strengthening of the MPFL is critical to knee health, especially for active sports participants. So understanding how to better protect these hidden ligaments could be the key to preventing knee injuries, don’t you think?
