Medial patellofemoral ligament reconstruction is superior to active rehabilitation in protecting against further patella dislocations.

For people who have dislocated their kneecap more than once but do not have the usual underlying anatomical risk factors, it has been unclear whether surgery to reconstruct the medial patellofemoral ligament, a stabilising structure on the inner knee, offers real benefit over physiotherapist-led rehabilitation alone. This trial randomised such patients to one of the two approaches and followed them for a year, tracking whether the kneecap became unstable again. Far more people in the rehabilitation-only group experienced further instability (41.9%) than those who had the surgery combined with rehabilitation (6.7%), a sizeable and statistically significant difference, though based on a relatively small sample of 61 patients. Interestingly, patient-reported knee function improved with rehabilitation alone, and function scores did not clearly differ between those who became unstable again and those who did not, suggesting instability itself did not always translate into worse reported function in this study.

If you have dislocated your kneecap more than once, this study looked at whether an operation to reconstruct a ligament on the inner side of the knee works better than physiotherapy-based rehabilitation alone at stopping future dislocations, specifically in people without major underlying anatomical risk factors. Over one year, dislocations happened again in far more people who had rehabilitation alone than in those who also had surgery.

This suggests surgery may lower the chance of another dislocation more than rehabilitation alone does, though the study was relatively small, with just over 60 participants split between groups. Interestingly, people who had rehabilitation alone still reported improved knee function, and people whose kneecaps became unstable again did not necessarily report worse day-to-day knee scores than those who stayed stable. This doesn't tell you what will happen in your own case, and a small trial like this cannot settle the question for everyone, but it does add evidence to a conversation that has mostly relied on recommendations rather than head-to-head comparison.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This randomised trial addresses a genuinely contested clinical question: for recurrent lateral patellar dislocation without significant trochlear dysplasia or an elevated tibial tuberosity-trochlear groove distance, is isolated medial patellofemoral ligament reconstruction (MPFL-R) actually superior to active rehabilitation, given that these same low-risk anatomical criteria are also used to justify conservative treatment after a first-time dislocation. At 12 months, persistent instability was reported in 41.9% of the rehabilitation-only group versus 6.7% of the MPFL-R group (relative risk 6.3, 95% CI 1.5-25.5), a statistically significant between-group difference despite the trial's modest size (30 and 31 patients per arm).

This informs the clinical reasoning that even in patients considered lower-risk, surgical stabilisation may meaningfully reduce further instability events compared with rehabilitation alone. Notably, rehabilitation alone still produced improvements in patient-reported outcomes, and persistent instability was not associated with significantly worse PROM scores regardless of group, which complicates any assumption that recurrent instability necessarily tracks with worse subjective function. The trial does not establish long-term outcomes beyond one year, nor does it address cartilage or degenerative risk, and the sample size, while adequate to detect this effect, limits generalisability across broader patient subgroups or longer follow-up.