Medial patellofemoral ligament (MPFL) tear

MEDIAL PATELLOFEMORAL LIGAMENT (MPFL) TEAR

A medial patellofemoral ligament tear is an injury to the main soft-tissue restraint that keeps the kneecap from moving too far to the outside. The medial patellofemoral ligament connects the inner side of the patella to the inner part of the femur and provides the majority of passive resistance against lateral patellar displacement, especially in the early degrees of knee flexion.

Most commonly, a medial patellofemoral ligament tear occurs during a lateral patellar dislocation or subluxation following a twisting movement, pivot or sudden change of direction with the knee slightly bent. People often report a sharp pain, a sensation that the kneecap has “popped out,” swelling and difficulty weight-bearing immediately after the incident. In some cases, damage to the medial patellofemoral ligament is associated with a higher risk of recurrent patellar instability episodes over time.

Key factors that influence treatment decisions

The medial patellofemoral ligament forms part of the medial soft-tissue complex that stabilises the patella and is estimated to provide more than half of the passive restraint to lateral patellar movement. Anatomically, it runs from the superomedial border of the patella to a region between the medial femoral epicondyle and the adductor tubercle and is often described as fan-shaped or hourglass-like in configuration. When this ligament is torn, the patella can shift more easily towards the outside, especially in early knee flexion, leading to a feeling of giving way, tracking problems or apprehension during specific movements.

Diagnosis is based on the description of the initial event (for example, a lateral patellar dislocation), clinical assessment with tests that stress and translate the patella and, when needed, magnetic resonance imaging to visualise the medial patellofemoral ligament and any associated bony or cartilage lesions. Management options include nonoperative care with bracing, protected weight-bearing and structured physiotherapy, as well as surgical medial patellofemoral ligament reconstruction for patients with persistent or recurrent instability, after a careful discussion of risks, benefits and expectations.

Physiotherapy after injury

For a medial patellofemoral ligament tear, physiotherapy is central in both nonoperative care and in post-operative rehabilitation. In a conservative approach, early goals include managing pain and swelling, protecting the knee from positions that promote lateral patellar shift and gradually restoring knee motion within a comfortable range. Bracing or taping is often used to support the patella, while exercises to activate the quadriceps, especially its medial portion, and the gluteal muscles are introduced to improve lower-limb alignment and control.

In later stages, rehabilitation emphasises closed-chain strengthening, balance and proprioceptive training, gait re-education and a graded return to activities involving cutting and pivoting, always monitoring how the knee responds. After medial patellofemoral ligament reconstruction, rehabilitation protocols focus on protecting the graft in the early weeks, avoiding excessive lateralisation of the patella and progressively increasing range of motion, strength and function according to clearly defined criteria. The overarching goals are to reduce instability episodes, restore confidence in the knee and support a safe return to daily and sporting activities.

Frequently Asked Questions

What is the medial patellofemoral ligament in simple terms?
It is the main ligament on the inner side of the knee that keeps the kneecap centred and stops it from moving too far outward.
How does the medial patellofemoral ligament usually tear?
It most often tears during a lateral kneecap dislocation after a twist, a sudden change of direction with a bent knee or sometimes a direct blow.
What are the common symptoms?
People often notice pain at the front or inner side of the knee, swelling, a feeling that the kneecap slips outward and lack of confidence with certain movements.
How can I tell if my pain is linked to kneecap instability?
A typical story is a kneecap that “pops out,” difficulty with sudden turns and a feeling of apprehension or catching when you bend your knee deeply.
What is the role of physiotherapy in nonoperative treatment?
Physiotherapy strengthens the quadriceps and hip muscles, improves balance and teaches safer movement patterns to reduce the chance of another instability episode.
How long does rehabilitation usually take?
It often takes several months, moving through phases of protection, strengthening and then higher-demand activities as criteria are met.
Can I keep walking while I still have symptoms?
Walking is usually allowed within comfortable limits, sometimes with support, while avoiding movements that clearly increase pain or instability.
Will I be able to go back to sports?
Often yes, provided you follow a structured rehabilitation plan and meet clear strength, control and functional criteria before returning to sport.
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