MPFL reconstruction or physiotherapy after a kneecap dislocation: which do I need?

What each approach aims to do

Physiotherapy strengthens the thigh and hip muscles, improves control of the knee during landing and turning, and builds confidence. It does not restore the torn medial patellofemoral ligament (MPFL), but it can help the muscles hold the kneecap in its groove.

MPFL reconstruction replaces the torn ligament with a tendon graft, restoring the main restraint that stops the kneecap sliding outwards.

Physiotherapy and MPFL reconstruction side by side

• Usually suits physiotherapy: a first dislocation with no loose fragment, a fairly normal kneecap groove and good recovery of confidence
• Usually suits surgery: two or more dislocations, persistent feelings of the kneecap slipping, a loose fragment that needs surgery anyway
• Recovery: physio often a few months of focused work; MPFL reconstruction usually around 4 to 6 months before full sport
• Main drawback of physio alone: in some knees the kneecap dislocates again
• Main drawbacks of surgery: stiffness, kneecap pain, the general risks of an operation
• Extra procedures: some knees also need tibial tubercle osteotomy or groove surgery, depending on anatomy

Factors that tip the balance

Young age, a shallow groove (trochlear dysplasia), a high-riding kneecap and loose joints all make recurrence more likely after physiotherapy alone. Teenagers in football, dance and basketball are a common group. Where these factors are strong, earlier surgery may be discussed even after one or two episodes.

When to see a knee surgeon in Doha

See a surgeon after any kneecap dislocation, ideally with an MRI, to check for a loose cartilage fragment. If the kneecap is still out of place, or the knee is very swollen and you cannot bend it, seek urgent care. At Aman Hospital, Dr. Gelber assesses stability, anatomy and the scan before advising physiotherapy or MPFL reconstruction.