Medial Patello Femoral Ligament (MPFL) reconstruction

Generally, trochlear problems are related to patellar (knee cap) problems. Knee cap problems can occur when the ligaments associated with them tear apart. One such ligament in the patella is the medial patellofemoral ligament (MPFL). This ligament helps in stabilizing the knee cap. It also prevents the patella from any sort of dislocation. When there is hyperflexion or twisting of the knee joint, the patella dislocates. Under such conditions, the MPFL ligament usually moves outwards. The ligaments may then tear off due to the abnormal stretching.

Diagnosis of the tear is done using X-rays, MRI etc. However, MRI can clearly depict the soft tissues (cartilages & ligaments) around the knee. In the case of complex cases, CT scan can help.

Non-surgical treatments are generally preferred. In situations where they do not yield any significant results, surgical treatments are performed. MPFL reconstruction is the major ligament reconstruction procedure done.

For reconstruction purposes, graft tissues are used. They are usually taken from the hamstring tendons from the back of the knee. The graft is collected from the inner portion of shin bone. After this process, a tunnel of suitable diameter is made in the patella using a burr (a drilling tool). One end of the hamstring is passed through this orifice. Incision is then made on the inner femur portion and both portions of the graft are placed into this incision. The inserted graft is fixed with a screw that jams the hamstring tendon to the tunnel. The side-to-side glide of the trochlea is then confirmed by the fibre-optic camera in the arthroscope.