Mpfl reconstruction for chronic pain

[bacalamuntoni]

Has anyone gotten a mpfl reconstruction for just maltracking? My knee does not have subluxation or dislocation? I'm in chronic pain been going to rehab for 2 years

[The_KNEEguru]

I am assuming you have already had an MPFL reconstruction? Please correct me if I am wrong and you are actually asking if it might help your current situation.

If you scroll down to 'Considerations' in this paper - "Medial patellofemoral ligament reconstruction: patient selection and perspectives" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6209364/ - you will see that the MPFL reconstruction procedure has problems in some patients. Contraindications to having the procedure in the first place includes:

1. patella alta (high-riding patella)
2. trochlear dysplasia (flattening of the upper part of the groove in which the patella lies)
3. enlarged TT-TG distance (the sideways displacement of the patellar tendon attachment in relation to the groove under the patella).

They also mention the procedure may be problematic for the younger patient, patients with hyper-mobile joints and athletes.

I would imagine that, despite your anatomy having been changed because of the MPFL procedure, it may still be possible to evaluate 1-3 via imaging to determine if you had underlying contraindications before the procedure was done. But then you would need an expert opinion as to how to proceed to try and alleviate your current discomfort...

If I have made a mistake in replying to your question, and you are asking if it might help your maltracking, the paper might still be useful to you.

[bacalamuntoni]

No I've never had a mpfl reconstruction my knee tracks lateral but it's not severe enough to be called a subluxation physio has not worked i have normal ttg distance and no trochlear dysplasia

[The_KNEEguru]

OK thanks - that clears things up. So it might be 'excessive lateral pressure syndrome' but there are other things that may be relevant, such as feet alignment, tibial or femoral torsion, plica....

Where do you experience the pain? Is there anything special that brings it on?

[bacalamuntoni]

OK thanks - that clears things up. So it might be 'excessive lateral pressure syndrome' but there are other things that may be relevant, such as feet alignment, tibial or femoral torsion, plica....

Where do you experience the pain? Is there anything special that brings it on?

Any activity for a long period of time brings it on and sitting down for a long period of time my right knee has no tilt and my left knee has a tilt both of them maltrack I feel pain in my knee caps

[The_KNEEguru]

Here is an article that may be helpful - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10550501/ - "Patellar malalignment: A common disorder associated with knee pain".

The author notes that

the most common predisposing factor is imbalanced peripatellar soft-tissue tension

and that

nonsurgical treatment of PM [patellar malalignment] should be considered first, while surgical treatment should follow established indications...

The author refers to two papers about MPFL reconstruction and says

medial patellofemoral ligament (MPFL) reconstruction is increasingly used in the treatment of PM with satisfactory results

, but in fact both papers are referring to patients who have had patellar dislocation, which is not your situation.

It must be really difficult for you to be in chronic pain - I do understand that.