MPFL Reconstruction in Nashville, TN
If your kneecap has slipped out of place once, the odds of it happening again are uncomfortably high. After two dislocations, recurrent instability rates climb above 50 percent, and every additional dislocation chips away at the cartilage under the patella. That cartilage does not grow back. MPFL reconstruction is the procedure that stops the cycle.
Dr. Damon H. Petty has spent more than 25 years rebuilding knees for athletes at every level, from Tennessee high schools to the NFL, MLB, NBA, and NHL. He is board-certified in Orthopedic Surgery and Sports Medicine, fellowship-trained under Drs. James R. Andrews and William Clancy, and has performed medial patellofemoral ligament reconstruction on teenagers with their first traumatic kneecap dislocation, young adults with recurrent patellar instability, and athletes whose prior surgery did not hold.
He practices through Tennessee Orthopaedic Alliance (TOA) with offices in Brentwood, Franklin, and Nashville, and treats patients throughout Middle Tennessee and the surrounding states.
What Is the Medial Patellofemoral Ligament (MPFL)?
The medial patellofemoral ligament is the primary soft-tissue stabilizer of the kneecap. It runs from the inner edge of the patella to the medial side of the femur, and it works like a leash that prevents the patella from sliding to the outside of the knee during bending, twisting, and pivoting.
Together the patella and femur form the patellofemoral joint, where the kneecap glides in a shallow groove called the trochlea. In a healthy knee, the quadriceps and surrounding ligaments keep the patella centered. The MPFL is the main restraint on the medial side. When it tears, the kneecap loses its primary check against lateral dislocation.
Some people are built with anatomy that puts the MPFL under extra load. A shallow trochlear groove, a high-riding kneecap (patella alta), ligamentous laxity, or a widened Q-angle all raise the chance of a patellar dislocation. Once the ligament is torn, the knee does not reliably return to normal on its own.
How the Medial Patellofemoral Ligament Gets Injured: Causes of Kneecap Injury
The medial patellofemoral ligament is most often injured during sport. Pivoting on a planted leg, cutting sharply, or taking a direct blow to the inside of the knee can all force the kneecap toward the lateral side of its groove and tear the patellofemoral ligament on the medial side. Football, basketball, soccer, tennis, gymnastics, volleyball, and cheerleading account for the bulk of cases Dr. Petty sees.
When the patella dislocates, it tears the soft tissue on the inside of the knee as it jumps the track. Even when the kneecap pops back into place on its own, the ligament usually does not heal in its original length. It scars down stretched or incompetent. The next pivot, bump, or hard landing can put the kneecap right back out.
Common symptoms after a first patellar dislocation include:
If you have had one full dislocation, you have roughly a one in three chance of another. After a second dislocation, the recurrence rate climbs above 50 percent. Each additional event raises the risk of cartilage damage behind the kneecap, deeper joint pain, and, over time, patellofemoral arthritis in the joint surfaces you will need for the next fifty years.
What Is MPFL (Medial Patellofemoral Ligament) Reconstruction Surgery?
Medial patellofemoral ligament reconstruction is a surgical procedure that rebuilds the torn patellofemoral ligament with a new tendon graft, restoring the medial restraint that holds the patella in its groove. It is the most reliable surgical treatment for recurrent patellar instability and for first-time dislocators who have significant cartilage damage, ongoing patellofemoral joint pain, or anatomic risk factors.
Dr. Petty performs MPFL reconstruction through two small incisions with arthroscopic assistance. The ligament reconstruction itself is a soft-tissue procedure, so patients avoid the pain and recovery that comes with cutting bone unless a concurrent osteotomy is needed. The surgery usually takes about an hour. Most patients go home the same day in a knee brace.
The ligament reconstruction works because it places a new, appropriately tensioned ligament on the exact anatomic footprint the medial patellofemoral ligament occupies on the patella and the medial femoral condyle. Outcomes are strong when the graft is placed isometrically, tensioned correctly, and secured with stable fixation. Redislocation rates after a properly executed ligament reconstruction are reported between 2 and 4 percent, compared with over 50 percent in untreated recurrent dislocators.
Who Is a Candidate for MPFL Ligament Reconstruction?
Dr. Petty typically recommends MPFL reconstruction for patients who have:
Had two or more patellar dislocations.
Suffered a first dislocation with a piece of cartilage knocked off the back of the kneecap or the femur.
Ongoing instability, apprehension, or a kneecap that subluxates during normal activity
A torn MPFL confirmed on MRI and a failed trial of physical therapy and bracing
An underlying anatomic predisposition (patella alta, trochlear dysplasia, increased TT-TG distance) alongside a traumatic dislocation
Adolescents with open growth plates are candidates too. MPFL reconstruction can be done safely without disturbing the physis, which is not true of every procedure that corrects patellar tracking. That lets Dr. Petty treat younger athletes early, before cartilage damage has a chance to progress.
Not every patient needs surgery. A first dislocator with a clean MRI and no cartilage injury often does well with a brace, structured physical therapy, and a return-to-sport progression. Dr. Petty takes time to determine which path fits the patient, rather than moving straight to the operating room.
Dr. Petty’s Approach to Medial Patellofemoral Ligament (MPFL) Reconstruction and Patellar Knee Instability
Dr. Petty has spent 25 years treating patellar instability, and the framework he uses has not changed much in that time: the decision between a soft-tissue reconstruction and a bony realignment depends on the patient’s anatomy, not a one-size protocol.
Every case starts with a detailed MRI-based assessment of the patellofemoral joint. Dr. Petty measures the TT-TG distance, trochlear depth, patella height (Caton-Deschamps index), and the integrity of the articular cartilage before recommending a procedure. He combines those measurements with an in-office exam that tests apprehension, tracking, and the competency of the medial restraints.
Based on that data he chooses from three surgical paths:
The point is not to do the biggest surgery possible. It is to match the procedure to the anatomy. An undercorrected knee keeps dislocating. An overcorrected knee develops arthritis early. The right operation lives in between.
Graft Options for MPFL (Medial Patellofemoral Ligament) Reconstruction
Dr. Petty uses an autograft or an allograft tendon depending on the patient’s age, activity level, and anatomy.
Whichever graft is chosen, Dr. Petty secures it with interference screws or suture anchors through a small tunnel in the patella and a second tunnel at the anatomic MPFL footprint on the medial femur.
How the MPFL Reconstruction Procedure Works
Dr. Petty performs MPFL reconstruction as outpatient surgery. Patients arrive a couple of hours before the procedure and go home the same day.
Recovery and Rehabilitation After MPFL Reconstruction
Recovery is demanding but predictable. Every milestone below assumes an isolated MPFL reconstruction. Recovery lengthens if a tibial tubercle osteotomy or cartilage repair is added.
The recurrence rate after a properly executed MPFL reconstruction is 2 to 4 percent. That number improves when the patient completes the full rehab program. Skipping rehab is the single biggest predictor of a second dislocation.
Why Nashville Patients Choose Dr. Petty as Their MPFL Reconstruction Surgeon
A handful of details set Dr. Petty apart from the other knee surgeons in Middle Tennessee.
He is dual board-certified in Orthopedic Surgery and in Sports Medicine. Most Nashville orthopedists hold one or the other.
He completed a sports medicine fellowship under Drs. James R. Andrews and William Clancy at the American Sports Medicine Institute in Birmingham, Alabama. Dr. Andrews is widely considered the most prominent sports medicine surgeon in the world, and the Andrews and Clancy fellowship is one of the most selective in the country.
He served as Head Orthopedic Team Physician for the Tennessee Titans from 2018 to 2026, was Head Orthopedic Surgeon for the Nashville Sounds during their Pittsburgh Pirates affiliation, and has been team physician for Tennessee State University for the past 15 years. Patellar dislocations are common in the teenage and collegiate athletes Dr. Petty has cared for his entire career.
Every patellofemoral case is planned from detailed MRI measurements and an in-office examination. Graft selection, tensioning, and the decision to add a tibial tubercle osteotomy or lateral release come from the patient’s anatomy, not a template.
Dr. Petty also personally performs PRP and BMAC (bone marrow-derived stem cell) injections under ultrasound guidance, and can augment cartilage repair with biologics when cartilage damage is found at the time of surgery. Patients often reach him because he offers the full spectrum of care under one roof.
The surgery, the injections, and the post-operative decisions come from Dr. Petty, not a delegate. His physician assistant, Jeff Tinker, is involved at every step of the care pathway, and patients routinely single Jeff out by name for thorough exams and clear communication.
What MPFL Reconstruction Patients Say About Dr. Petty
“Dr Damon Petty tells me like it is. Gives me options with all pros and cons then allows me to make the decision. He repaired my meniscus in 2023. I am hiking, playing softball and walking up and down the stairs because of his ability.”
— Cheryl Odom
“It’s always such a pleasure to see Dr. Petty. I know that I am under the care of a true professional who cares for the injury as needed, with easy solutions where available. I have had a full recovery from my lateral meniscus knee surgery almost 2 years ago and if I need anything again, he will be where I return.”
— Jennifer Ghanem
“Dr Petty is a wonderful doctor. He is brilliant in diagnosing your issue and knowing what to do. If there are options, he explains those. He is very calm, kind and listens. He repaired my meniscus, repaired my college baseball player son’s shoulder, then he patiently dealt with my 89 yr old mother when she broke her shoulder and arm.”
— Janice Goodwin
Great expertise and knowledge on where the medicine should be applied and why.
— Healthgrades
Frequently Asked Questions About MPFL Reconstruction Surgery
Schedule an MPFL Reconstruction Consultation with Dr. Petty
If you or your child has had a kneecap dislocation and it is starting to happen again, an evaluation is the right next step. Dr. Petty and his team will review the MRI, examine the knee, explain the options clearly, and help you decide whether MPFL reconstruction is the right path.
We serve patients from Nashville, Brentwood, Franklin, Murfreesboro, Hendersonville, Gallatin, Lebanon, and the greater Middle Tennessee area. Dr. Petty also sees patients who travel for world-class care, some from over 500 miles away, including recent patients from Kansas City, drawn by his specific expertise and reputation.
