Patellar Stabilisation Surgery
Patellar instability, commonly known as kneecap instability or patella dislocation/subluxation, occurs when the kneecap does not track smoothly within its groove on the thigh bone (femur). This can lead to pain, recurrent dislocation, a sense of the knee “giving way,” and difficulty with daily and sporting activities. Recurrent instability can also cause cartilage damage over time.
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.
Why Surgery May Be Recommended
Surgery is considered when:
- You have recurrent patellar dislocations or subluxations.
- Symptoms persist despite focused rehabilitation.
- There are anatomical factors that predispose to instability (e.g., shallow groove, high kneecap position – patella alta).
- You are unable to return to normal activities due to instability or pain.
The goal of surgery is to restore stable kneecap tracking, reduce the risk of further dislocations, protect the cartilage, and improve knee function.
The Procedure
Patellar stabilisation isn’t a single operation — it’s a group of procedures tailored to your specific underlying problem. The surgery is typically carried out as a day case and is performed under general anaesthetic. Surgical techniques may include:
Medial Patellofemoral Ligament (MPFL) Reconstruction
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.
Tibial Tubercle Osteotomy (TTO)
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 top of the shin bone and moving it down 1-2cms to place the patella in a more anatomical position.
Other procedures (e.g. Trochleoplasty, Lateral Release, Medial Plication, Femoral De-rotation) may be used depending on your anatomy.
Recovery & Rehabilitation
Recovery varies with the type and extent of surgery.
Immediate Post-operative Phase
- Pain and swelling are managed with ice, elevation, and medication.
- You may use crutches initially.
- A brace may be needed if a bone realignment (osteotomy) was performed.
Early Rehabilitation (0–6 weeks)
- Gradual recovery of motion and early strengthening.
- Physiotherapy is essential to restore muscle control, particularly of the quadriceps.
- VMO Quads muscle wasting can be minimised with a muscle stimulator (NMES) if available. [needs to have a high intensity contraction setting] Gains best seen in first 2-6 weeks.
Mid to Long-Term (6 weeks – 3 months)
Full recovery can take 3–6 months or more, especially after combined procedures like osteotomy.
Most patients can return to normal daily activities by 8–12 weeks, and sporting activity later as advised.
Frequently Asked Questions
What is patella stabilisation surgery?
It is an operation to restore stable kneecap tracking and reduce the risk of dislocation, typically by reconstructing ligaments like the MPFL and/or realigning bony structures.
What symptoms suggest instability?
Recurrent dislocations, a sensation of the knee “giving way,” anterior knee pain, and swelling can all be signs of patellar instability.
Can I try physiotherapy first?
Yes — a structured physiotherapy programme focusing on strengthening and control is often effective initially and should be the first step unless symptoms are severe.
How long is recovery?
Recovery varies but is typically between 3–6 months, depending on the surgery performed and physiotherapy adherence.