Arthroscopie du genou

The knee joint is stabilized by many key tendons and ligaments, one of which being the medial patellofemoral ligament (MPFL). The MPFL plays a crucial role in stabilizing the patella (kneecap) and preventing it from dislocating laterally. Injury to the MPFL often occurs due to trauma or sports-related activities and impacts, and can lead to recurrent patellar dislocations and instability.

MPFL reconstruction surgery is performed to restore stability to the knee by reconstructing the damaged ligament. This procedure is especially recommended for patients with recurrent patellar dislocations or those who have failed conservative treatment, such as a knee brace or physiotherapy.
‍
During MPFL reconstruction, the surgeon typically uses minimally invasive techniques. A small incision is made to access the knee joint, and the damaged MPFL is reconstructed typically using an allograft. The surgeon drills small holes in the patella and the femur (thighbone) to create tunnels for the graft. The graft is then threaded through these tunnels and secured with screws or other fixation devices. This restores the function of the MPFL, stabilizing the patella and preventing future dislocations. The procedure usually takes about 1-2 hours.

MPFL reconstruction is a generally safe procedure, but it carries some risks, which include:
‍
● Graft failure or re-injury
● Patellar fracture
● Infection
● Knee stiffness
● Nerve or blood vessel injury
‍
General minor risks associated with surgery and anesthesia include nausea, vomiting, headaches, sore throat, and urinary retention. Major general risks include blood clots, potentially leading to heart attack or stroke, allergic reactions, and pneumonia. Your surgeon will make sure to discuss the relevant risks with you prior to your surgery and take precautions to minimize the risk of any complications.

Your pre-surgical preparation will include a thorough physical examination of your knee, with an appropriate workup consisting of imaging studies such as X-rays or MRI, and potentially blood tests. Your surgeon will discuss the type of graft and technique to be used, as well as the anesthesia options, which may include general or regional anesthesia.
‍
Pain management will involve a multimodal pain control strategy consisting of different modalities, ranging from acetaminophen (e.g. Tylenol) and NSAIDs (e.g. Advil, Aleve) to opioids (e.g. oxycodone), and potentially nerve blocks, when a regional nerve gets frozen with the injection of a local anesthetic medication.

After an outpatient MPFL reconstruction, you can typically expect to go home the same day, provided your surgeon determines that your recovery is on the right track. Your postoperative care will focus on pain management, with an emphasis on early mobilization and physical therapy. Patients typically begin rehabilitation soon after the surgery, starting with gentle range-of-motion exercises and progressing to strengthening, agility, and balance exercises. Crutches may be used for the first few weeks, and a knee brace may be recommended to protect the reconstruction.
‍
Most patients can return to daily activities within the first few months, but return to high-impact activities and sports may require a longer rehabilitation period, often 6 to 12 months. The goal of your therapy is to restore full knee function and prevent future injuries. Regular follow-up appointments with your surgeon will help ensure your recovery is on the right track.