MPFL Reconstruction

Not always, but it depends on your anatomy. For most first-time dislocators, a structured rehabilitation program focused on quadriceps and hip strength reduces but does not eliminate re-dislocation risk. However, imaging findings matter significantly: if CT or MRI shows trochlear dysplasia (a flat or convex femoral groove), patella alta (high-riding kneecap), or a TT-TG distance greater than 20 mm, the mechanical setup of your knee makes the kneecap prone to re-dislocation regardless of how well you rehabilitate. Young patients with these anatomical risk factors who depend on their knees for sport often choose early surgery over waiting for a second dislocation.

The TT-TG (tibial tubercle to trochlear groove) distance measures how far laterally the tibial tubercle — the bony bump below the kneecap where the patellar tendon attaches — sits relative to the center of the femoral groove. A higher number means the kneecap is being pulled more strongly toward the outside of the knee throughout the range of motion. When TT-TG exceeds 20 mm, a tibial tubercle osteotomy (moving the attachment point medially) is typically added to MPFL reconstruction to address the mechanical malalignment, not just the torn ligament.

Most patients report that the instability feeling — the sense that the knee could give way — resolves completely after successful MPFL reconstruction. Cartilage damage from prior dislocations can cause ongoing aching that surgery does not fix; that is a separate problem from instability. Return to sport rates are high (over 80% in most studies), though some patients describe a persistent mild awareness of the reconstructed knee that is not painful but noticeable. Full functional recovery takes 6-9 months, and the knee often continues to improve subtly through the first year.