Medial Patellofemoral Ligament Reconstruction: Sam’s Story

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Sam, 16, bunted during a friendly baseball game in the Summer of 2019. But instead of running to first, he collapsed at home base. “The pain in my knee was so intense,” Sam says. “I knew I did something wrong.”

Sam and his parents Sam with his parents at graduation, after knee reconstruction surgery at CHOP Everyone watching the game was stunned: No one or nothing had touched him. His body simply crumpled. As Sam lay on the ground, screaming and clutching his right knee, he didn’t know or understand what happened. “It felt like my knee just popped,” Sam says. “Then, I couldn’t get up on my own.”

His coach and teammates rushed onto the field and helped him to the sidelines where a coach quickly iced Sam’s injured knee, and his mom, Ali, hovered nearby. About a half hour later, Sam was finally able to stand without bearing weight on his right leg. Limping, Sam headed home with his mom.

Imaging finds ligament tear

Once home, the pair told Sam’s dad, Dan, what happened. Alarmed, Dan “wanted me to get an MRI that night,” Sam recalls. A few months before, Sam’s younger brother, Ethan, had suffered a similar knee injury – his knee “popped,” and he collapsed while playing basketball.

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The family headed to a nearby hospital in Doylestown for an examination and testing. Doctors ordered an MRI of Sam’s knee and discovered Sam had torn his medial patella femoral ligament (MPFL) – a small but crucial ligament that attaches to the inside part of the kneecap (patella) and holds it in place where the femur (thigh bone) and tibia (the larger of two shin bones) meet.

Doctors recommended non-surgical treatment including rest and physical therapy (PT) three days a week for three months. If Sam injured his knee in the same way again, however, the family would need to consider surgery.

After PT and rest, Sam says he was “feeling 100 percent” and was excited to begin league baseball in the fall of his junior year of high school.

Unfortunately, fate had other plans.

Second injury

Sam was at league baseball tryouts when his kneecap popped out again. “It was the first pitch! I swung and connected, but then collapsed again. I was so mad. I just kept thinking: why does this have to happen now?”

Another MRI confirmed he had again torn his MPFL. Without surgical treatment, Sam’s knee would remain unstable, and his active lifestyle would be over.

Local doctors referred the family to Theodore J. Ganley, MD, at the Children’s Hospital of Philadelphia (CHOP). In addition to being director of CHOP’s Sports Medicine and Performance Center, Dr. Ganley is also an internationally known expert on knee repair and reconstruction.

MPFL reconstruction surgery at CHOP

Within days, Dr. Ganley examined Sam, reviewed his imaging results, and discussed treatment options with Sam and his family. Dr. Ganley recommended MPFL reconstruction, an operation that would stabilize Sam’s knee and protect the joint from additional damage.

Sam and his parents agreed and soon after Dr. Ganley performed outpatient surgery on Sam’s leg. During the procedure, Dr. Ganley removed a small portion of a muscle in Sam’s thigh, then reattached it in his knee – essentially acting as a replacement part for the torn-beyond-repair MPFL – reconnecting the kneecap to the thigh bone to strengthen the joint.

Sam went home the same day, sporting a large brace on his right leg -- from ankle to upper thigh—that immobilized his knee so it could heal.

Recovery after MPFL surgery

For the first two weeks after his MPFL surgery, Sam says he “pretty much laid in bed with my leg propped up on a pillow.” He could not put any pressure on his knee except when he was supervised in PT.

After a couple of weeks, Sam returned to school using a wheelchair. As his recovery progressed, Sam was able to walk with crutches and a leg brace, then just the leg brace. Sam continued PT throughout his recovery.

After 8 weeks, Dr. Ganley cleared Sam to remove the leg brace and begin working on his own. Sam needed crutches for a few days to give him extra support but was quickly walking without assistance.

Cleared to return to baseball after knee reconstruction

Sam at bat Sam is back to playing baseball after MPFL surgery Sam continued PT for another four months, then in early March 2020, he was cleared to play competitive baseball once again. However, the COVID-19 pandemic interrupted his return to the field. But when his high school team began to practice together again, the return to baseball – even with COVID restrictions – helped Sam “feel more normal.”

When school and sports resumed in fall 2020, Sam was able to resume competitive baseball with a spot on his school’s league team, rotating between second base and shortstop. The season allowed Sam to experiment and test how far he could push his reconstructed knee while playing, running and sprinting.

When Spring baseball began in March 2021, Sam was more than ready. In the team’s first game of the season, Sam scored two homeruns – a remarkable feat considering his injury and recovery months before.

“I’m really happy with the results of my surgery,” Sam says. “It made my knee stronger and helped me return to a game I love. We should make it to the playoffs this year.”

Sam credits Dr. Ganley and Physician Assistant Benjamin J. Forst, PA-C, for educating him about what to expect during surgery and throughout his recovery. “They let me know when I should rest, and when I could really push myself again,” Sam says.

Now that Sam’s high school baseball career is complete, he’s looking forward to studying kinesiology at Penn State University in the fall. Then, maybe medical school. Sam adds: “I’m taking it one step at a time.”

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