Patella instability and stabilisation surgery

Instability of the patella (kneecap) can cause pain and prevent normal activities due to a feeling of apprehension that the patella will dislocate. If your doctor recommends surgery, a stabilisation procedure is performed to change the tracking of the patella and strengthen the soft tissues that prevent it from dislocating.

What is patella instability?

Patella instability involves a patient having a sensation of their kneecap feeling loose and unstable. It may be associated with pain and swelling in the front of the knee. Patients usually experience loss of function in the knee.

What causes patella instability?

Your kneecap is usually right where it should be – resting in a groove at the end of the thighbone (femur). When the knee bends and straightens, the patella moves straight up and down within the groove. Sometimes, the patella jumps out of its location, resulting in patella instability. This can occur after a hard blow or fall or through anatomical or genetic causes. It can also result from a previous patella dislocation injury.

What are the symptoms associated with patella instability?

General symptoms include:

Knee pain and/or swelling
Feeling the kneecap shift or slide out of the groove
Feeling the knee give way or buckle
Hearing a popping sound when the patella dislocates
A change in the knee’s appearance
Apprehension or fear when running or changing direction.

What are the non-surgical treatment options for patella instability?

Typically, non-surgical treatment is all that most initial cases require.Your doctor may recommend physiotherapy to rebuild the Vastus Medialis (VMO) muscle. You might wear a brace for several weeks to stabilise the knee while it heals. Crutches might be recommended to take the weight off the knee. Once the knee starts to heal, your doctor might recommend physiotherapy to help you regain normal motion. Specific exercises will strengthen the thigh muscles holding the knee joint in place.

What are the surgical treatments for patella instability?

Patella stabilisation surgery may be appropriate if patella instability / dislocation develops into a repeated issue that becomes unresponsive to physiotherapy. Identifying the correct procedure(s) to perform requires careful physical examination and assessment of specialised scans of the knee. Patients with moderate instability usually require Medial Patellofemoral Ligament Reconstruction. This involves transferring a hamstring tendon to make a new ligament to compensate for the damaged one. For severe cases of patella instability, a Medial Patellofemoral Ligament Reconstruction in addition to a Patella Tendon-Tibial Tubercle Transfer may be required to improve tracking. A Trochleoplasty is a rare treatment to deepen the femoral groove to allow better tracking. These surgeries are a combination of open and arthroscopic techniques, and most patients stay one or two nights in hospital.

Are there any exercises that can prevent recurring patella instability?

Regular exercise, such as cycling, can strengthen quadriceps muscles and help prevent future patella injuries. Swimming, water aerobics and the elliptical trainer are other suitable exercises. Make sure you use a pad under your knees when kneeling.