Patella Stabilisation Surgery

Patella Stabilisation Surgery

This is a specialised procedure aimed at addressing issues related to patella (kneecap) instability, which can cause pain, discomfort, and dislocation. This condition is often caused by abnormal alignment of the patella or damage to the surrounding ligaments. Jonathan utilizes his expertise in knee surgery to provide effective treatment for patients suffering from recurrent patella dislocations or instability. By carefully assessing the underlying causes of the instability, Jonathan can perform a tailored patella stabilisation surgery, which may involve realigning the patella, tightening or reconstructing ligaments, deepening the trochlea groove and repairing any damaged tissue. The goal of the surgery is to restore proper tracking of the patella, reducing the risk of future dislocations and improving knee function. Jonathan’s approach ensures that each patient’s surgery is personalised to their unique anatomy, leading to optimal results and a quicker recovery. With his advanced knowledge and skill, Jonathan is dedicated to helping patients regain knee stability and return to their active lifestyles with confidence.

When non-operative treatment has failed, then it may be suitable to undergo surgical management. Surgical treatment may also be necessary after a single dislocation in the setting of having a cartilage injury needing repair.

The surgical prescription aims at addressing one or all of the abnormal anatomy that leads to the dislocation. French orthopaedic surgeons, who have been considered the pioneers of patellofemoral stabilisation surgery coined this the “à la carte” treatment philosophy.

Where the trochlea groove is misshapen significantly and considered to be the main contributing factor, then a procedure to reshape the trochlea groove to match the patella may be performed. This procedure is called a trochleoplasty and is reserved for when there is evidence of severe trochlea dysplasia.

When the patella is high riding (patella alta), then a procedure may be performed to bring the patella down to an appropriate height such that it fits the trochlea. This is called a tibial tubercle osteotomy and involves cutting the bone at the front of the tibia where the patella tendon attaches and reattaching the bone with the tendon still attached further down the tibia. Screws are used to fix the bone back down. This is often combined with a small soft-tissue realignment of the tissues surrounding the patella to fine tune the movement of the patella. Tibial tubercle osteotomy may be performed alone or in combination with other stabilising procedures.

Frequently, the medial patellofemoral ligament (MPFL) is ruptured and is poorly functioning, in which case reconstruction of the MPFL ligament can be performed. This procedure often involves using one of the hamstring tendons that is then attached to the patella and tunnelled underneath the soft tissue on the inner side of the knee to be attached to the corresponding location on the femur. The aim of this is to restore the MPFL function and prevent further dislocation. MPFL reconstruction may be performed alone or in combination with other stabilising procedures.

In most of these stabilisation procedures, an arthroscopy (key hole surgery) is performed at the same time to assess/treat any cartilage damage and to confirm and ensure that a satisfactory result of the stabilisation procedure has occurred.

Recovery from these procedures is on an individual basis depending on which procedure, or combination of procedures, have been performed. Usually, the hospital stay for a MPFL reconstruction is overnight but if in combination with other procedures is from two to three nights. There may be the need for a knee brace and crutches to be used for 6 to 8 weeks following tibial tubercle osteotomy.