When a patient dislocates their kneecap, tissues on the inside aspect of the knee tear allowing the kneecap (or patella) to dislocate to the outside. The Medial Patellofemoral Ligament, also known as the MPFL, is the main soft tissue restraint to dislocation of the patella. It is torn when dislocation occurs. Sometimes the MPFL heals well enough that dislocation does not occur again, but 50% of the time or more, the MPFL does not heal sufficiently so dislocation recurs. For the patient that continues to have dislocation episodes surgery is usually considered in the form of MPFL Reconstruction. Reconstructing the MPFL restores the tether to keep the patella in its groove when it might dislocate.
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Dr. Steensen developed a technique to reconstruct the MPFL that uses a part of the quadriceps tendon to take the place of the injured ligament. A portion of the quadriceps tendon is kept attached to the patella and re-routed to the inside aspect of the femur (thigh bone). This lays over the same position as the original MPFL so it will replicate its function.

It is typically an outpatient procedure and one can put weight on the leg immediately. A knee immobilizer and crutches are used for a few weeks. Strengthening takes a few months before one can return to sports.
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As Published in the Spring/Summer 2010 edition of Good Health, a Mount Carmel publication

For most of us, intellectual curiosity leads to the Internet or the library. For Dr. Robert Steensen, it led to a cadaver lab in Memphis, Tennessee.

While that may seem odd, consider the fact that Steensen is an orthopedic surgeon with The Cardinal Orthopedic Institute. And while most of us associate a cadaver lab with scary movies, Dr. Steensen saw it as the perfect place to study a theory he had about repairing dislocated kneecaps.

"The more patients I saw with second and third patella dislocations, the more I thought about the traditional approach being taken to repair them," said Dr. Steensen. "The main injury in each case was to the medial patellofemoral ligament (MPFL). The standard solution had been to either tighten the ligament or to realign the bones in the knee. Since these were patients who'd had repetitive injuries, it seemed like an approach in need of study."

So that's what he did.

The first step in his research took him to Memphis, where he looked to replicate the function of the MPFL - studying its location and how it tightened or loosened with flexion and extension of the knee. What he theorized through discovery was that using a replacement ligament that is already attached to the kneecap and attaching its free end to the femur could represent a better long-term repair.

"A normal MPFL runs sideways from the inside of the kneecap to the inside of the femur," said Dr. Steensen. "Since most patients don't have surgery the first time they dislocate the kneecap, by the time they have a second injury, the existing ligament is no longer reparable. With the technique we developed, the ligament remains attached to the patella while a small (8-10 cm) portion of the quadriceps tendon is detached, flipped, turned 90 degrees toward the inside and attached to the femur. The result is essentially a new MPFL."

The second part of Dr. Steensen's research involved putting his technique into practice and studying the results in an initial group of patients. Not surprisingly, the results were good.

Since, like other MPFL reconstructions, it is an open surgical procedure, there was a fair amount of muscle atrophy afterwards. But according to Dr. Steensen, most patients were back to normal activities within a month, and, with formalized rehabilitation and physical therapy, were back to playing soccer, basketball or softball within three to four months. The procedure and results were documented in medical journals like The American Journal of Sports Medicine, Arthroscopy and Orthopedics.

While Dr. Steensen performs the procedure regularly at Mount Carmel West and even gets referrals from out of state, his research continues. Today it focuses more on the anatomical predispositions (patella groove depth and bone alignment) that lead many young athletes to need the surgery and what can be done to resolve them.

"It remains very intellectually challenging for me," he said. "The procedure we developed is more evolutionary than revolutionary, but it's not as straightforward as it sounds. There are a lot of variables to consider in performing it and, as always, we're continuing in our quest to find a better way."
© 2016 Robert Steensen, MD