Medial Patellofemoral Ligament (MPFL) Injury
One of the numerous ligaments on the medial aspect of the knee is the medial patellofemoral ligament (MPFL). The MPFL helps to maintain the patella centered in the Patellofemoral groove on the front of the knee. The Medial Patellofemoral ligament opposes lateral patellar subluxation by providing resistance to any movement outside of the knee, therefore preventing lateral patellar migration. Also, It prevents lateral patellar dislocation by providing 50 to 80 percent of the restraining force.
Causes and symptoms of Medial patellofemoral ligament injury:
- Between 0 and 30 degrees of knee flexion, the medial Patellofemoral ligament is most effective. The MPFL injury is most usually caused by traumatic dislocation of the patella induced by twisting traumas to the straight knee. Pain and tenderness will be felt along the medial retinaculum. A kneecap dislocation incident, or series of episodes, would have been excruciatingly painful.
Trauma to the MPFL or laxity of the MPFL might result in future patellar instability. Tearing of the Vastus medialis obliquus (VMO) muscle and anterior tearing of the medial retinaculum might result from lateral dislocation of the patella induced by MPFL tearing. In combination with patellar dislocation caused by MPFL ripping, an osteochondral fracture of the lateral femoral condyle and fracture of the medial patellar facet may be detected.
Patients with a high riding patella, ligamentous laxity, or weak knee musculature are at a higher risk of MPFL injuries. Physiotherapy is used to treat the majority of MPFL injuries. If the MPFL tear is of grade 3, surgery will be required.
PHYSIOTHERAPY TREATMENT OF MPFL INJURIES INCLUDES:
MPFL Partial tear or tear of Grade 1 or 2 can be treated with immobilization for 2-4 weeks.
During the period of immobilization start with only foot and ankle motion, do not move the knee.
On day 2- start gentle Isometric quadriceps strengthening (press the knee on the pillow or towel roll), hold for a count of 5, and relax. Repeats 5 times every 2-3 hours.
Walking non-weight bearing for first 3 weeks.
After the 4th week when the rigid strap or immobilization remove-
Start passive knee bending, bend the knee to 5 degrees with the support of your hand, you may also move the leg from side to side.
Assisted straight leg lift-
loop a long towel or rigid band or dupatta around your foot and gently raise the leg to 30 degrees, lower it to 5 degrees and raise it again. Repeat 5 times and do this 3 to 4 times per day. As you get the strength and are pain-free you can try to lift the leg straight up without external support.
Week 5-6 –Progress from partial to full weight-bearing with crutches or walker, can also walk on stairs with partial weight-bearing.
In addition, After week 6- straight leg raise, Adductor (inner thigh) raise, Back leg raises.
Leg press- utilizing a thera-
band or thera-tube to strengthen the muscle at the front of the leg. Take a mild resistance tube and grasp it with both hands. Loop it around your foot, bend your knee, and push on the tube until your knee straightens. Rep 10 times more. And three times a day. Increase the tube resistance gradually.
Wrap a thin resistance thera-band around your knee (knee 30-degree bend) Extend the knee against the resistance of the thera band (avoid hyper-extension). Perform 10 repetitions three times each day.
Also, Place a cushion beneath the knee for a short arc quadriceps exercise. (30-degree knee bend) Put a folded towel between your knees. Tighten the muscles in your thighs and elevate your heel off the bed. (Avoid locking the knee.) Perform 10 repetitions three times each day.
PHYSIOTHERAPY TREATMENT POST-SURGERY OF MPFL:
Post-OP Day 0-7
Firstly, Cryo compression over the leg for 15 minutes every 2 hours.
Post-OP Day 2-14
Secondly, Walk with the brace locked in extension. You may unlock it to perform your exercises.
CPM- you may give a CPM for knee range of motion. Start at 0-30 degrees, and increase 5 degrees every 12 hours until you are at 90 degrees use it for 6 hours/day for 6 weeks.
Early post-operative phase (0-2 weeks)
Continue Cryo-compression therapy.
Passive ROM exercises.
Patellar manual mobilization.
Post-operative phase 1 (2-6 weeks)
Post-operative phase 2 (6-12 weeks)
Begin proprioception exercises.
Active knee ROM exercises.
Strengthening exercises- wall slides, step up & down.
Post-operative phase 3 (12-18 weeks)
In addition, Weight training.