Patellofemoral Instability

Conservative Treatments for Patellofemoral Instability

If your kneecap is only partially dislocated (subluxation), your physician may recommend non-surgical treatments, such as pain medications, rest, ice, physical therapy, knee-bracing, and orthotics. If the kneecap has been completely dislocated, the kneecap may need to be repositioned back in its proper place in the groove. This process is called closed reduction.

Surgical Treatments for Patellofemoral Instability

Surgery is sometimes needed to help return the patella to a normal tracking path when other non-surgical treatments have failed. The aim of the surgery is to realign the kneecap in the groove and to decrease the Q angle.

Patellar realignment surgery is broadly classified into proximal re-alignment procedures and distal re-alignment procedures.

Proximal re-alignment procedures: During this procedure, structures that limit the movements on the outside of the patella are lengthened or ligaments on the inside of the patella are shortened.

Distal re-alignment procedures: During this procedure, the Q angle is decreased by moving the tibial tubercle towards the inner side of the knee. The surgery is performed under sterile conditions in the operating room under spinal or general anesthesia. The surgeon will make two or three small cuts around your knee. The arthroscope, a narrow tube with a tiny camera on the end is inserted through one of the incisions to view the knee joint. Specialized instruments are inserted into the joint through other small incisions. The camera attached to the arthroscope displays the image of the joint on the monitor. A sterile solution will be pumped into your knee to stretch the knee and provide a clear view and room for the surgeon to work. With the images from the arthroscope as a guide, the surgeon can look for any pathology or anomaly and repair it through the other incisions with various instruments.

After the evaluation is completed, a larger incision is made over the front of the knee. Depending on your condition, a lateral retinacular release may be performed. In this procedure, the tight ligaments on the outer side of the knee are released, thus allowing the patella to sit properly in the femoral groove.

Your surgeon may also tighten the tendons on the inside, or medial side of the knee to realign the quadriceps.

In cases where the malalignment is severe, a procedure called a tibial tubercle transfer (TTT) will be performed. In this procedure, a section of bone where the patellar tendon attaches to the tibia is removed. This bony section is then shifted and properly realigned with the patella and reattached to the tibia using screws. Once the malalignment is repaired and confirmed with arthroscopic evaluation, the incisions are closed with sutures.

Postoperative Care Following For Patellofemoral Instability

Your doctor will recommend pain medications to relieve pain. To help reduce the swelling, you will be instructed to elevate the leg and apply ice packs over the knee. Crutches are necessary for the first few weeks to prevent weight-bearing on the knee. A knee immobilizer may be used to stabilize the knee. You will be instructed about the activities to be avoided and exercises to be performed for a faster recovery. A rehabilitation program may be advised for a speedy recovery.

Risks and Complications Following Surgical Treatment of Patellofemoral Instability

Possible risks and complications associated with the surgery include:

  1. Loss of ability to extend the knee
  2. Recurrent dislocations or subluxations
  3. Arthrofibrosis (thick fibrous material around the joint)
  4. Persistent pain

Patients with patellofemoral instability have problems with the alignment of the kneecap. Therefore, treatment is necessary to bring the kneecap back into normal alignment. Your surgeon will decide which procedure is appropriate for your condition.

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