How to treat a medial patellofemoral ligament (MPFL) tear and injuries
Learn what causes MPFL tears and injuries, plus how to heal them with conservative treatments like knee exercises from Hinge Health physical therapists.
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You might be familiar with ACL and MCL ligament injuries in the knee, but have you heard of the MPFL? The medial patellofemoral ligament (MPFL) is a lesser-known part of the knee that helps guide the kneecap (patella) during movement. If the MPFL has an injury or tear, it can lead to knee pain and changes in knee stability.
“MPFL injuries often happen after the kneecap moves out of its usual position,” says Kim Anderson, PT, DPT, a physical therapist at Hinge Health. Although these injuries are more common in athletes, anyone can experience them during everyday activities, a fall, or even after a car accident. Some people may also be more prone to MPFL injuries due to joint hypermobility or laxity in their knee ligaments. Regardless of the cause, exercise therapy and rest are keys to recovering from MPFL injuries.
Read on to learn more about MPFL tears and injuries, their causes, and how to treat them with exercises recommended by Hinge Health physical therapists.
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What is the medial patellofemoral ligament (MPFL)?
The MPFL is a ligament that connects your kneecap to the inner part of your thigh bone, or femur. This short, strong band of connective tissue helps keep your kneecap stable as you move.
MPFL injuries and tears
If your knee twists during a fall or while making a quick change in direction, you can irritate, sprain, or tear your MPFL. Sprains can be mild or more severe requiring surgery. A physician or PT can determine which type of sprain or tear you may have based on your symptoms, Dr. Anderson says. Sometimes, imaging is needed to confirm.
Symptoms of an MPFL injury
Symptoms vary depending on the nature of the MPFL injury, but will likely always occur after the knee cap moves out of its normal position towards your outer knee. Here are some common symptoms of MPFL issues:
Sharp pain initially, then more of a dull ache
A popping sound at the time of injury
Swelling
Bruising, usually on the inside of the knee
A feeling of instability or giving way at the knee
Clicking, popping, or catching sounds when moving the knee
Stiffness or limited range of motion
Difficulty walking
Kneecap that shifts or slides with movement
Causes of MPFL injuries
MPFL injuries usually happen when the kneecap shifts out of its usual spot — sometimes just briefly (called a subluxation), or more fully (called a dislocation), Dr. Anderson says. During a subluxation, the kneecap moves out of the groove and then returns on its own. A dislocation means the kneecap shifts enough that it needs to be treated by a professional. When the kneecap moves toward the outside of the knee, the MPFL can become overstretched, sometimes leading to a tear. Some situations where this might occur include:
A direct hit. “Direct impact to the inside of your knee is one of the most common reasons for an MPFL injury,” says Dr. Anderson. This often happens in contact sports like football, soccer, hockey, or basketball, but can also occur with a fall or during a car accident.
Twisting. When your foot is planted and your knee twists forcefully, it can overstretch the MPFL. This type of sudden movement often happens in sports like soccer, football, and basketball, or activities like skiing, tennis, or pickleball. It can also happen in everyday activities, such as losing your balance and twisting your knee while going down stairs.
Collisions. Colliding with someone — whether on the field, court, or slopes — can sometimes injure the MPFL.
Muscle weakness. Being sedentary, changes that come with aging, and muscle imbalances can reduce support around the knee, which can make the knee more susceptible to an MPFL injury.
A history of dislocations. Previous kneecap dislocations can make your knee feel less stable, especially if the injury wasn’t fully rehabilitated the first time.
Anatomical factors. Everyone’s knees have their own unique movement patterns, which may play a role in MPFL injuries, Dr. Anderson says. While you can’t change these factors, building strength in the muscles around your knee (such as your quadriceps in the front of your thighs) can help you feel more stable and supported during movement.
Exercises for MPFL injury recovery
Want expert care? Check if you're covered for our free program →- Quad set
- Straight leg raise
- Seated hamstring squeeze
- Single leg stance
- Wall squats
- Forward step up
These targeted exercises can help rebuild strength in your knee and restore function after an MPFL injury. Start with these gentle isometric movements that activate the muscles around your knee without requiring you to bend it. As your MPFL heals from a sprain, bending can be painful. Once swelling subsides, you can introduce more dynamic movements into your routine.
The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.
Physical therapy (PT) is for more than just recovering from surgery or injury. It’s one of the top treatments for joint and muscle pain. It helps build strength, improve mobility, and reduce pain. And it doesn't always need to be in person.
Hinge Health members can conveniently access customized plans or chat with their care team at home or on the go — and experience an average 68% reduction in pain* within the first 12 weeks of their program. Learn more*.
Treatments for MPFL tear
First-time and minor MPFL injuries can often be treated conservatively. However, more serious injuries may require additional treatment such as immobilization or surgery. Whether you need surgery or not, exercise will be a big part of your recovery. In some cases, it may even help you avoid surgery. Common treatments include:
Try physical therapy and targeted exercises. Targeted exercises can help restore strength and balance in surrounding muscles that share the load with your knees. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. A PT can help you modify exercises and activities if you need to minimize weight-bearing activities. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.
Follow the P.E.A.C.E and L.O.V.E. protocol. This newer recovery model is more comprehensive than the traditional R.IC.E. method (rest, ice, compression, and elevation), making movement — instead of rest — a central part of your recovery plan while still protecting and rehabbing an injured knee.
Apply heat or ice. While either may help you feel better, ice can help reduce swelling and numb pain immediately after an injury. After swelling subsides, heat can aid healing by increasing blood flow to the area and reducing stiffness. Consider trying both methods to see which one feels best for you.
Knee bracing. If knee instability is affecting your comfort or confidence during exercise or physical therapy, a brace may help. But it’s not a replacement for exercise therapy. Ask your doctor or physical therapist about bracing advice.
Follow advice about weight-bearing movements. You may need to limit the amount of weight you put on your injured knee as the MPFL heals. Be sure to follow your doctor’s or PT’s recommendations.
TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle electrical impulses to interact with your nervous system and help reduce pain associated with conditions like MPFL issues. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable.
Reconstruction surgery. While most people do well with conservative treatments, sometimes surgery is recommended — especially if your knee feels very unstable, you’ve had repeated dislocations, or you’re an athlete hoping to return to sports. Physical therapy and exercise therapy will be important for your recovery and can even help you prepare for surgery. “The more range of motion and strength you build beforehand, the smoother your recovery tends to be,” says Dr. Anderson.
When to see a doctor
Mild to moderate MPFL sprains often improve on their own with conservative treatments; more serious injuries may require additional treatment or surgery. It’s important to see a provider if your symptoms are severe, get worse, or start to make daily activities harder. It’s also a good idea to get care if you have:
Swelling that affects your ability to bend or extend your knee
Inability to bear weight on the affected leg
Kneecap feels unstable, like it’s catching or sliding during movement
PT tip: keep up with your exercises
“Recovery looks different for everyone and depends on how severe the injury is,” says Dr. Anderson. “It’s important to take the time to regain your full strength and movement after an MPFL injury, and keep your knee and lower body muscles strong to help reduce the risk of future injuries.”
How Hinge Health can help you
If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.
The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.
Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.
See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.
This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.
References
1. Liu, Z., Yi, Q., He, L., Yao, C., Zhang, L., Lu, F., Zhang, X., Wu, M., Geng, B., Xia, Y., & Jiang, J. (2021). Comparing Nonoperative Treatment, MPFL Repair, and MPFL Reconstruction for Patients With Patellar Dislocation: A Systematic Review and Network Meta-analysis. Orthopaedic Journal of Sports Medicine, 9(9), 232596712110266. doi: 10.1177/23259671211026624
2. Ashish Keoliya, & Ramteke, S. U. (2024). A Case Report on Medial Patellofemoral Ligament Reconstruction Rehabilitation in a Cricket Player Through Targeted Agility Training. Cureus. doi: 10.7759/cureus.56002
3. Vitale, T. E., Mooney, B., Vitale, A., Demitra Apergis, Wirth, S., & Grossman, M. G. (2016). PHYSICAL THERAPY INTERVENTION FOR MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION AFTER REPEATED LATERAL PATELLAR SUBLUXATION/DISLOCATION. International Journal of Sports Physical Therapy, 11(3), 423. https://pmc.ncbi.nlm.nih.gov/articles/PMC4886810/
4. Watson, R., Sullivan, B., Stone, A. V., Jacobs, C., Malone, T., Heebner, N., & Noehren, B. (2022). Lateral Patellar Dislocation. JBJS Reviews, 10(5). doi: 10.2106/jbjs.rvw.21.00159