Patellar Stabilisation
Patellar instability (knee cap dislocation) can be treated using a variety of techniques that target the issues contributing to dislocation / instability. It is recommended to consider surgery only after an unsuccessful trial of non surgical management with high quality focused rehabilitation.
The complexity of the surgery required depends on the potential problems that are identified through clinical examination and imaging studies (X-ray, MRI, CT). Sometimes stabilisation with just a graft from the knee cap to the thigh bone is required. In more significant instability, osteotomy surgery to the shin bone maybe necessary. The more extensive the surgery required to address the cause of your instability, the greater the amount of time you will need for recovery and rehabilitation post-operatively.
The Procedure
The surgery is typically carried out as a day case and is performed under general anaesthetic. The medial patellofemoral ligament (MPFL) reconstruction requires harvesting a tendon (gracilis) from the inside of your leg just below your knee. This graft is then connected from the femur (thigh bone) to the patella (knee cap) to act as a restraint to the excessive movement of the knee cap.
If you have a patella that sits too high (Alta) you may also require the additional of a tibial tubercle osteotomy. This involves cutting the bone at the front of the knee and moving it down 1-2cms to place the patella in a more anatomical position.
Recovery
The bandage stays on for 48 hours, while the dressing below can remain for 10-14 days. Most patients are allowed to start using their knee immediately as knee stiffness and muscle wasting can be an issue
If the osteotomy was also required you may be placed in a brace after surgery and limited in the amount of weight you can take through the leg in the first 2-3 weeks until the bone begins to heal.
Full recovery can take between 3-4 months.