MPFL Reconstruction in Sydney
MPFL reconstruction rebuilds the ligament that helps hold your kneecap in place. It is commonly used for recurrent patella dislocation or ongoing kneecap instability, with surgery and rehabilitation planned together to help you trust your knee again.
What is MPFL reconstruction?
MPFL reconstruction is surgery to treat kneecap dislocation or patella instability. The medial patellofemoral ligament, or MPFL, is a strong band of tissue on the inner side of the knee that helps keep the kneecap tracking in the groove at the end of the thigh bone.
When the kneecap dislocates, it often stretches or tears the MPFL. Once this ligament is damaged, the kneecap can feel unstable, untrustworthy or at risk of popping out again, especially with twisting, sport, stairs or sudden changes in direction.
The operation uses a graft to reconstruct the MPFL. This helps guide and stabilise the kneecap as the knee bends, reducing the risk of recurrent dislocation and helping you return to activity with more confidence.
Do you need MPFL reconstruction?
MPFL reconstruction is most often considered when the kneecap has dislocated more than once, or when a first traumatic dislocation leaves the knee feeling unstable and difficult to trust despite good rehabilitation. For many first-time dislocations, initial treatment is non-surgical with bracing, physiotherapy and gradual return to sport.
You may be more likely to benefit if you have recurrent patella dislocations, ongoing apprehension that the kneecap may slip out, difficulty returning to sport, or instability that affects daily activities. It can be especially useful when the main problem is a torn MPFL after a traumatic dislocation and the rest of the kneecap anatomy is suitable.
The MPFL is only one part of kneecap stability. Some people also have a shallow groove, high-riding kneecap, abnormal alignment or a tibial tubercle position that increases the risk of dislocation. In those cases, other procedures such as tibial tubercle osteotomy, trochleoplasty or knee arthroscopy may be needed as well.
At your consultation, your surgeon will examine kneecap tracking, stability, range of motion and quadriceps control. Imaging may include X-rays, MRI and sometimes CT scans to assess cartilage damage, MPFL injury, trochlear shape, patella height and alignment.
Benefits and risks
What you can expect it to achieve
- Reduce the risk of recurrent kneecap dislocation
- Improve confidence in a knee that feels unstable or untrustworthy
- Help the kneecap track more securely in its groove
- Support return to sport, running and change-of-direction activity
- Allow associated problems, such as loose fragments or cartilage damage, to be assessed during arthroscopy
- Provide a structured rehabilitation pathway for strength, balance and return to activity
Risks to understand
- Common and temporary: swelling, bruising, stiffness and discomfort around the inner knee or graft site
- Uncommon: infection, blood clots, wound problems, nerve irritation and anaesthetic complications
- Specific to MPFL reconstruction: graft stretching, graft rupture, recurrent instability, stiffness or ongoing kneecap pain
- Procedure-related: pain at a hamstring graft site if your own tendon is used
- Longer-term: MPFL reconstruction improves stability but may not fully resolve pain if cartilage injury or patellofemoral arthritis is present
All surgery carries risk and outcomes vary between individuals. The aim of your consultation is to understand why your kneecap is unstable, not simply to reconstruct the ligament in isolation.
MPFL reconstruction and other procedures
Isolated MPFL reconstruction can work well when the main problem is ligament injury after patella dislocation. But if the kneecap is being pushed out of position by bone shape or alignment, a ligament reconstruction alone may not be enough.
A tibial tubercle osteotomy can change the pull of the patella tendon. A trochleoplasty can reshape a severely abnormal groove. Arthroscopy can assess and treat loose fragments or cartilage damage. Your surgeon will explain whether these are relevant to your knee.
| Procedure | Why it may be used |
|---|---|
| MPFL reconstruction | Rebuilds the ligament that helps stop the kneecap slipping outwards |
| Knee arthroscopy | Assesses cartilage damage, loose fragments and associated injury inside the knee |
| Tibial tubercle osteotomy | Changes the pull of the patella tendon when alignment contributes to instability |
| Trochleoplasty | Reshapes a severely abnormal trochlear groove in selected patients |
| Cartilage treatment | May be considered when dislocation has damaged the joint surface |
The procedure: what happens
You will arrive at hospital one to two hours before surgery. MPFL reconstruction is usually performed as day surgery under a general anaesthetic, meaning you are asleep for the procedure. Your anaesthetist may also use local anaesthetic or a nerve block to reduce pain after you wake up.
Before the procedure begins, your surgeon will confirm the correct knee and mark the side. A tourniquet may be inflated around the upper thigh to reduce bleeding and improve visibility.
Your surgeon will often begin with a knee arthroscopy through two or three small incisions at the front of the knee. The knee is filled with sterile saline, and a camera is inserted to assess the joint, patella tracking, cartilage surfaces and any damage from previous dislocations.
The graft is then prepared. This may be a synthetic graft or, in some cases, one of your hamstring tendons. If a hamstring tendon is used, a small incision is made on the inside of the shin below the knee to harvest the graft.
The graft is passed under the skin and soft tissues along the path of the original MPFL. It is fixed to the inner edge of the kneecap and to the femur using anchors, screws, buttons or other fixation devices. The tension is checked carefully so the kneecap is supported without being over-tightened.
At the end of the procedure, the incisions are injected with local anaesthetic, closed with dissolvable sutures and sealed with dressings or glue. Surgery usually takes one to two hours, with additional time before for anaesthetic and after for recovery.
After surgery
You will wake in the recovery room and be monitored until comfortable and stable. Many patients go home on the same day. If surgery is later in the day, or if comfort, pain control or mobility are concerns, an overnight stay may be recommended.
You will usually be given crutches before leaving hospital. Many patients can put weight through the leg immediately after isolated MPFL reconstruction, although this may change if additional procedures such as tibial tubercle osteotomy or cartilage treatment were performed.
When to seek help. Contact us or seek urgent care if you develop fever, increasing calf pain or swelling, chest pain, shortness of breath, spreading redness, wound discharge, severe pain that is not improving, or a new dislocation episode. Concerned about your recovery? Call (02) 9437 9794.
MPFL reconstruction recovery and rehabilitation
Recovery after MPFL reconstruction is usually faster than many ligament reconstructions in the early walking phase, but full return to sport still takes time. The graft needs to settle, the quadriceps needs to recover, and the brain needs to trust the knee again.
Most patients use crutches at first and are walking more normally within two to four weeks. A brace may be used in some cases to restrict bending or improve confidence, especially if additional procedures were performed. Your surgeon will explain whether you need one and for how long.
Recovery timeline
| Phase | Timeframe | What to expect |
|---|---|---|
| Protect & settle | Weeks 0–2 | Crutches, swelling control, wound care, gentle knee movement and early quadriceps activation |
| Walking & movement | Weeks 2–6 | Normalising walking, improving range of motion, reducing brace or crutch use if appropriate |
| Strength & control | Weeks 6–12 | Progressive strengthening, balance work, cycling and patella tracking control |
| Running preparation | Months 3–6 | Higher-level strength, single-leg control, landing mechanics and gradual running preparation |
| Return to sport | Months 6–12 | Agility, change of direction, sport-specific loading and return-to-sport testing |
Timeframes are a guide. Current MPFL rehabilitation literature supports criterion-based progression rather than relying on time alone.
Post-operative care
The bulky dressing can usually be removed the morning after surgery. Small waterproof dressings underneath should stay in place until your wound check at 10 to 14 days, unless they become loose or soaked. Some fluid may ooze into the dressings over the first 24 to 48 hours and may have a faint red colour.
You can shower with waterproof dressings, but avoid soaking the knee in a bath, pool or ocean until the wounds have healed. Swelling can last for several weeks, and incision sites can feel puffy or firm for up to three months.
Rehabilitation at MTP Health
This is where MTP Health is different. Your rehabilitation is delivered by our physiotherapists and exercise physiologists in the same clinic as your surgeon, following an MPFL rehabilitation pathway based on your procedure, sport and risk factors.
We recommend booking your first post-operative physiotherapy appointment as soon as your surgical date is confirmed, ideally two to five days after surgery. Your physiotherapist will help manage swelling and stiffness before progressing knee movement, quadriceps strength, balance and confidence.
Later rehabilitation focuses on single-leg control, running mechanics, change of direction, jumping, landing and sport-specific exposure. The goal is not just to return you to activity, but to reduce the risk of another instability episode.
Returning to driving, work and sport
Returning to driving usually takes a minimum of six weeks for right knee surgery and around two weeks for left knee surgery in an automatic car. You must be able to safely perform an emergency stop and must have stopped all painkillers other than over-the-counter medications such as Panadol or Nurofen. Please also check with your car insurer.
Most office workers can return to work after one to two weeks, depending on pain, swelling, transport and the ability to elevate the leg. Heavy manual workers may require two to three months before resuming full duties, especially if the job involves ladders, kneeling, squatting, uneven ground or heavy lifting.
Returning to high-risk sports such as netball, soccer, AFL, rugby, basketball and skiing should be gradual and testing-based. Some athletes begin sport-specific work from four to six months, but full return to pivoting competition often takes closer to nine to twelve months, especially when strength, balance, confidence and landing mechanics still need work.
Stability is only part of the result. MPFL reconstruction helps control the kneecap, but your best outcome depends on swelling control, quadriceps strength, movement quality and a measured return to sport.
MPFL reconstruction cost in Sydney
The cost of MPFL reconstruction depends on your private health cover, hospital insurance, surgeon fees, anaesthetist fees, assistant fees, hospital charges and whether other procedures such as knee arthroscopy, cartilage treatment, tibial tubercle osteotomy or trochleoplasty are performed at the same time.
If you are having surgery using private health cover, the standard fees for the surgeon, anaesthetist and assistant usually lead to a total out-of-pocket payment of around $3,500. This is the gap left after Medicare and your health fund have paid their rebates.
The anaesthetist is an independent practitioner and may charge a different gap, which can affect the final figure. We provide their details and recommend checking their quote before committing to surgery.
The surgeons at MTP Health participate in various reduced-gap schemes run by different health insurance providers. Availability can vary, and reduced-gap surgical time slots may involve a longer wait. Your insurance may also have an excess to pay, commonly around $500.
If you are having MPFL reconstruction through the public system, there is no out-of-pocket surgical cost, but waiting times can be long and depend on your local hospital, urgency category and availability.
Why have your MPFL reconstruction at MTP Health
MTP Health brings together experienced knee surgeons, physiotherapists and exercise physiologists in one clinic. That matters because kneecap instability is not always caused by one structure. The right plan needs to identify whether the MPFL alone is the issue, or whether alignment, groove shape, cartilage damage or movement control also need to be addressed.
Honest advice comes first. If your knee is better suited to non-surgical care, we will tell you. If MPFL reconstruction is appropriate, we will explain why. If another procedure should be considered, we will talk you through the reasoning clearly before you decide.
Your surgeon
Dr Jonathan Negus
Dr Negus is a fellowship-trained hip and knee surgeon who works alongside MTP Health's physiotherapy and exercise physiology team so your surgery and rehabilitation are managed as one plan.
View full profile →Frequently asked questions
What is MPFL reconstruction?
MPFL reconstruction is surgery used to treat kneecap dislocations or instability. When the kneecap dislocates, it stretches or tears the ligament on the inner side of the knee that connects the kneecap, or patella, to the thigh bone, or femur.
This ligament usually helps keep the kneecap in its groove as the knee bends. When it is torn, the kneecap is at higher risk of popping out of its groove again.
The surgery uses a graft to reconstruct that ligament. This helps stabilise the kneecap and reduces the risk of more dislocations. Other procedures are sometimes needed alongside MPFL reconstruction, including tibial tubercle osteotomy, trochleoplasty and knee arthroscopy.
How can I best prepare for MPFL reconstruction?
The most important preparation is to have a settled knee with minimal swelling or effusion, and to get the quadriceps, or thigh muscles, as strong as possible.
The best results are usually achieved when working with a sports-focused physiotherapist who is in communication with your surgeon.
At MTP Health, we take preparation seriously. We want your knee moving well, your swelling controlled, your quadriceps switched on and your expectations clear before surgery.
What happens before MPFL reconstruction?
Before your surgery, the hospital will contact you to confirm the time you need to arrive and when you need to start fasting.
If you are on a morning list, you usually need to stop all food from midnight and drink clear fluids only until 5:30am or two hours before the planned start of the list, whichever comes first.
For afternoon lists, the food fasting time is usually 11am. Clear fluids include water, clear apple juice with no bits, or clear sports drink such as Gatorade. Clear fluids do not include milk or cloudy juice with pulp.
What happens during knee MPFL reconstruction?
You will arrive at hospital between one and two hours before surgery and can usually go home on the same day. One of our anaesthetists will give you a general anaesthetic, meaning you will be asleep for the procedure. They may also use local anaesthetic around some nerves in your leg to reduce pain after you wake up.
A tourniquet may be inflated around your upper thigh to reduce blood flow and allow a clear view inside the knee. Your surgeon may make two to three small incisions at the front of the knee and fill it with sterile saline. A telescope, called an arthroscope, is inserted into the knee to look for damage or injured areas.
The graft is then prepared. This is usually synthetic, although in some cases the surgeon may harvest one of your hamstring tendons. If a hamstring graft is used, a small incision is made over the inside of your shin bone just below the knee joint.
The graft is passed under the skin and soft tissues from the inner edge of the kneecap to the inner side of the femur. It is fixed to the kneecap and femur with anchors, sutures, screws, buttons or other fixation devices. The tension is checked carefully before the wounds are closed.
At the end of the procedure, the incisions are injected with local anaesthetic, closed with dissolvable sutures and glued or dressed to create a strong waterproof closure. Surgery usually takes one to two hours, with extra time before for anaesthetic and after for recovery.
What should I expect immediately after MPFL reconstruction?
You should experience mild to moderate discomfort after waking from MPFL reconstruction. Pain is usually controlled with medication for a short period.
Length of stay — It is often safe to go home on the day of surgery. If surgery is later in the day, or if comfort and mobility are concerns, staying overnight may be recommended.
Walking — You will be given crutches before leaving hospital for safety. Most patients can put weight through the leg immediately after isolated MPFL reconstruction and are walking more normally within two to four weeks. Restrictions may be different if additional procedures were performed.
Bracing — A brace is used in some cases to restrict bending or improve confidence. If needed, it may be used for several weeks.
Dressings — The bulky dressings can usually be removed the morning after surgery. Small waterproof dressings underneath should stay on until your wound check at 10 to 14 days. You can shower with these dressings, but avoid soaking in the bath, pool or ocean.
What is my rehabilitation following MPFL reconstruction?
It is vital that you engage with physiotherapy to maximise your early recovery from surgery.
At MTP Health, we recommend booking your first post-operative physiotherapy appointment as soon as your surgical date is confirmed. This should usually be two to five days after surgery. We will communicate the rehabilitation plan with your treating physiotherapist, whether that is one of our team or your own physio.
Your physiotherapist will help manage swelling and stiffness before progressing leg strength and function. Later, they will help improve your level of function for your chosen sport or activity and develop your program to reduce the risk of further injury.
The MPFL rehabilitation protocol we use is based on current research, clinical experience and objective progression targets.
When can I return to driving, work and sport after MPFL reconstruction?
Driving — Returning to driving usually takes a minimum of six weeks for right knee surgery and around two weeks for left knee surgery in an automatic car. You must be able to safely perform an emergency stop and must have stopped all painkillers other than over-the-counter medications such as Panadol or Nurofen. Checking with your car insurer is recommended.
Work — The knee may remain swollen for up to six weeks, and the incision sites are often puffy and firm for up to three months. Most office workers can return after one to two weeks. Heavy manual workers may require two to three months before resuming full duties.
Sport — Returning to high-risk sports such as netball, soccer, footy and basketball takes time and should be guided by strength, balance and function testing. Sport-specific training may begin earlier, but full return to pivoting sport often takes closer to nine to twelve months. Returning too early increases the risk of graft failure or further dislocation.
What are the risks of MPFL reconstruction?
MPFL reconstruction surgery is generally safe, but all joint surgeries carry some general risks. The most common side effects are temporary pain, bruising, swelling and stiffness.
Blood clots — These are uncommon but can cause calf swelling and pain. A deep vein thrombosis can rarely travel to the lungs and cause a pulmonary embolism.
Graft-site pain — If a hamstring tendon is used, you may feel pain or discomfort at the donor site. This usually settles with time and pain relief.
Infection — Infection is very uncommon. A superficial wound infection may need antibiotics. If infection enters the joint, further surgery may be needed to wash out the knee.
Skin numbness — Small skin nerves around the knee are cut during surgery, which can leave a small numb patch near the scar. This usually shrinks over time.
Joint stiffness — Most patients feel stiff after surgery. This usually improves over days to weeks, but excessive internal scarring, called arthrofibrosis, can occasionally cause longer-term stiffness.
Graft rupture or recurrent instability — The graft can stretch or fail, particularly if the knee is overloaded too early or if underlying alignment issues are not addressed.
Other uncommon complications include anaesthetic risks, allergic reaction to medications, heart complications and stroke.
How much does MPFL reconstruction cost?
As always with the health system, the answer is: it depends.
At MTP Health, our mission is to simplify healthcare through a better understanding of the system upfront. You can discuss the options specific to you with the team when you see your specialist.
If you are having surgery using private health cover, the standard fees for the surgeon, anaesthetist and assistant usually lead to a total out-of-pocket payment of around $3,500. This is the gap left after Medicare and your health fund have paid their rebates.
The anaesthetist is an independent practitioner and may charge a different gap, which can affect this figure. We always provide their details and recommend checking their quote before committing to surgery.
The surgeons at MTP Health participate in various reduced-gap schemes run by different health insurance providers. Please check availability of surgical time slots first, as there may be a longer wait for this option.
Your insurance may also have an excess to pay, commonly around $500. If you are having the operation through the public system, there is no out-of-pocket surgical cost, but you may need to wait up to a year depending on hospital availability and urgency category.
Is MPFL reconstruction always enough to stop kneecap dislocation?
Not always. MPFL reconstruction can be very effective when the main issue is a torn or stretched MPFL after dislocation.
However, some people have underlying anatomy that keeps pushing the kneecap out of position. This may include a shallow groove, high-riding kneecap, abnormal alignment or a tibial tubercle position that increases lateral pull.
If these factors are significant, your surgeon may discuss additional procedures such as tibial tubercle osteotomy or trochleoplasty.
Will MPFL reconstruction fix kneecap pain?
The main goal of MPFL reconstruction is stability, not pain relief alone. Many people feel more confident and comfortable once the kneecap stops slipping, but pain can be more unpredictable.
If there is cartilage damage behind the kneecap, overload, weakness or patellofemoral arthritis, some pain may persist even if stability improves.
MPFL reconstruction consultations across Sydney
North Shore Health Hub, Level 4, Suite 401, 7 Westbourne St, St Leonards NSW 2065
St Leonards consulting →173 Warringah Road, Beacon Hill NSW 2100 — serving the Northern Beaches
Beacon Hill consulting →Also consulting at Gosford, Wahroonga, Castle Towers and Tamworth.
Talk to a surgeon about kneecap instability
Book a consultation to find out whether MPFL reconstruction is right for your knee — and if it is not, to leave with a clear plan for the most suitable next step.
Book a ConsultationPrefer to talk? Call (02) 9437 9794 · GP & physio referrals: referrer information
- American Academy of Orthopaedic Surgeons, Unstable Kneecap (Patellar Instability) patient guidance.
- Current Concept Review: Medial Patellofemoral Ligament Reconstruction — rehabilitation and return-to-sport guidance.
- Current patellar instability literature on MPFL reconstruction, tibial tubercle osteotomy and trochleoplasty indications.