Medial patellofemoral ligament (MPFL) reconstruction is a proven surgical solution for those experiencing recurrent kneecap (patellar) instability. While the vast majority of patients experience restored stability and a return to active lifestyles, a small number may face complications or failure after surgery.
Recognizing the signs of a failed MPFL reconstruction early can help ensure the best outcome possible. For in-depth information about MPFL surgery and recovery, read this comprehensive overview: MPFL Reconstruction Surgery.
What Is Considered a Failed MPFL Reconstruction?
A failed MPFL reconstruction is generally defined by:
- Persistent or recurrent patellar instability: This includes continued episodes where the kneecap dislocates or feels like it may “give way,” especially during twisting movements, sports, or daily activities.
- Disabling anterior knee pain: Ongoing pain at the front of the knee that significantly limits your function or activity.
- Stiffness and loss of range of motion: Difficulty straightening or bending the knee, which may require more aggressive physical therapy or even surgical intervention.
- Postoperative complications: Infection, ongoing swelling, or abnormal wound healing that affects recovery and function.
Signs Your MPFL Reconstruction May Have Failed
Consider speaking with your orthopedic team if you experience any of the following after MPFL reconstruction:
- Recurring Instability: If your kneecap continues to dislocate, sublux (shift partially out of place), or feels unstable, particularly during motion or athletic activity.
- Persistent Pain: Ongoing, moderate to severe pain at the front or inner side of the knee, especially if it is similar to or worse than before the surgery.
- Loss of Range of Motion: You notice new or worsening stiffness, inability to extend or flex the knee, or “catching” sensations that restrict movement.
- Swelling or Heat: Swelling or warmth around the knee joint that does not improve with time.
- No Functional Improvement: Lack of progress in physical therapy, difficulty returning to normal activities, or regression post-surgery.
If you’ve had MPFL reconstruction and notice a return or worsening of instability, pain, or stiffness, don’t hesitate to seek an evaluation. Early intervention can often make a great difference in your outcome.
Possible Causes of MPFL Reconstruction Failure
According to clinical experience and recent studies, failure may be attributed to:
- Technical factors: Incorrect placement or tensioning of the reconstructed ligament during surgery.
- Unaddressed anatomical factors: Such as patella alta (high-riding kneecap), trochlear dysplasia (shallow groove at the femur), or limb alignment issues.
- Graft problems: Stretching or tearing of the new ligament.
- Poor healing or infection: Delayed wound healing, infection, or scar tissue formation.
- Unrecognized risk factors: Generalized ligament laxity may predispose to recurrent instability.
MPFL Reconstruction Failed: Now What?
If you suspect your MPFL reconstruction has failed:
- Consult your orthopedic surgeon. A thorough history, exam, and imaging (X-rays, MRI) are often required to precisely define the cause of failure, including evaluation of graft integrity and bone structure.
- Do not delay evaluation. Persistent pain or instability could lead to additional problems if not promptly addressed.
- Consider a second opinion. If symptoms are unexplained or persist despite treatment, specialized assessment may be necessary.
- Revision surgery can often address persistent problems, but outcomes depend on finding and correcting the underlying cause(s).
Recognize Success (and When to Get Help)
First and foremost, don’t worry: most patients experience excellent outcomes after MPFL reconstruction if performed by an experienced surgeon and followed by proper rehabilitation. However, recognizing early warning signs of a failed MPFL reconstruction can help ensure that you manage any setbacks promptly, maximizing your chance of a full and lasting recovery.
Learn more about MPFL reconstruction, including how to ensure the best possible outcome following surgery. If you’d like to make an appointment for a second opinion, please reach out.
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