Medial Patellofemoral ligament is one of severalligaments on the medial aspect of the knee. The MPFL help to keep the patellacentered along the front of the knee within the Patellofemoral groove. The MedialPatellofemoral ligament provides resistance to any movement towards outside ofthe knee which is lateral patellar subluxation, so it resist lateral migration ofthe patella. It provides about 50 to 80 percent of restraining force to lateralpatellar dislocation.
Medial Patellofemoral ligament is most effectivebetween 0 to 30 degree of knee flexion.
The MPFL injury most commonly occur due to traumaticdislocation of the patella caused by twisting injuries to the knee when it isstraight.
There will be pain and tenderness along the medialretinaculum. An episode or multiple episodes of kneecap dislocation which wouldhave been very painful.
Traumatic injury or laxity of the MPFL can causefuture patellar instability.
Lateral dislocation of the patella caused due to MPFLtearing can lead to Tearing of Vastus medialis Obliquus (VMO) muscle andanterior tearing of the medial retinaculum.
An osteochondral fracture of the lateral femoralcondyle and fracture of the medial patellar facet may be seen in associationwith patellar dislocation caused due to MPFL tearing.
Patients with high riding patella, ligamentouslaxity or weak musculature of the knee joint are at the high risk of MPFLinjuries.
Most of the MPFL injury are treated withphysiotherapy management. If the tear of MPFL is of grade 3, then this wouldrequires surgery.
PHYSIOTHERAPYTREATMENT OF MPFL INJURIES INCLUDES:
MPFL Partial tear or tear of Grade 1 or 2 can betreated with immobilization for 2-4 weeks.
During the period of immobilization start with onlyfoot and ankle motion, do not move the knee.
On day 2- start gentle Isometric quadricepsstrengthening (press the knee on the pillow or towel roll), hold for a count of5 and relax. Repeats 5 times in every 2-3 hours.
Walking non-weigh bearing for first 3 weeks.
After 4th week when the rigid strap or immobilizationremove-
Start passive knee bending, bend the knee to 5degree with the support of your hand, you may also move the leg from side toside.
Assisted straight leg lift- loop a long towel orrigid band or dupatta around your foot and gently raise the leg to 30 degree,lower it to 5 degree and raise again. Repeat 5 times and do this 3 to 4 times perday. As you get the strength and are pain free you can try to lift the legstraight up without external support.
Week 5-6 -Progressfrom partial to full weight-bearing with crutches or walker, can also walk onstairs with partial weight bearing.
After week 6- straight leg raise, Adductor (innerthigh) raise, Back leg raises.
Leg press- to strengthen the muscle in the front ofthe thigh, using a thera-band or thera-tube. Take light resistance tube, gripthe tube with both your hands. Loop it around your foot and bend the knee andthen push against the tube till the knee straightens. Repeat 10 times. And 3times a day. Gradually increase the tube resistance.
Loop a light resistance thera-band around the knee (knee30 degree bend) Extend the knee against the thera band resistance (avoidhyper-extension). Do 10 repetition 3 times a day.
Short arc quadriceps- place a pillow below the knee.(knee bend 30 degree). Place a folded towel between the knees. Tighten your thighmuscles and lift your heel off the bed. (do not lock the knee). Do 10 repetitionsfor 3 times a day.
PHYSIOTHERAPYTREATMENT POST-SURGERY OF MPFL:
Post-OP Day 0-7
Cryo compression over the leg for 15 minutes inevery 2 hours.
Post-OP Day 2-14
Walk with the brace locked in extension. You mayunlock it to perform your exercises.
CPM- you may given a CPM for knee range of motion. Startat 0-30 degree, and increase 5 degree every 12 hours until you are at 90degrees use it for 6hours/day for 6 weeks.
Early post-operative phase (0-2 weeks)
Continue Cryo-compression therapy.
Passive ROM exercises.
Patellar manual mobilization.
Ankle-toe movement.
Quads isometrics.
Post-operative phase 1 (2-6 weeks)
Heel slides.
SLRs.
Post-operative phase 2 (6-12 weeks)
Begin proprioception exercises.
Active knee ROM exercises.
Strengthening exercises- wall slides, step up &down.
Core strengthening.
Gait training.
Stationary bi-cycle.
Post-operative phase 3 (12-18 weeks)
Sports specific activities.
Agility training.
Plyometric.
Aerobics exercises.
Weight training.
Pilates.