Patella Dislocation Treatment | Orthopaedic Knee Specialists

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Patella Stabilisation Surgery

Do you have issues with patella dislocations?

This is a complex condition and evaluation by a knee specialist is recommended

Unfortunately, there is no single operation that will ‘fix’ all scenarios. Every person has unique anatomy and risk factors and our knee surgeons will evaluate you for these.

In the acute setting, if you have dislocated your patella for the first time, it is important to be reviewed to ensure that you have not ‘knocked’ a piece of your cartilage off into your knee joint. This happens frequently and is often not visible on the initial Xrays. An Arthroscopy to remove | repair this piece is required. The remainder of this article focuses on stabilisation techniques for people who are experiencing multiple patella dislocations.

If you have difficulty with recurrent patella dislocations, then you are a candidate for stabilisation surgery to prevent this from occurring.

READ MORE ABOUT PATELLA INSTABILITY

Soft Tissue Vs Bony Procedures

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Patella dislocation treatment (stabilisation surgery) requires a thorough understanding of the underlying cause for patella ‘instability’. Procedures designed to address patella instability can be thought of as either:

Soft Tissue

These procedures are designed to ‘reconstruct’ or ‘tighten’ the medial soft tissue restraints (MPFL) of the patella (kneecap). Occasionally the lateral (outer) soft tissues are very tight, causing the kneecap to be ‘pulled’ out of position. These can be released via keyhole methods if required.

Bony

The most common bony procedure involves re-positioning the tibial tuberosity. The tibial tuberosity is the area of bone on the tibia (shin bone) that the patella tendon attaches to. The medical term for this procedure is “Tibial tubercle osteotomy”

MPFL Reconstruction

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The medial patellofemoral ligament (MPFL) is a band of tissue that connects the medial (inner) side of the kneecap to the femur (thigh bone). The MPFL is responsible for keeping the patella in its groove, when the leg is bent in the range from 0-30 degrees. When the patella dislocates, the MPFL is torn. Simply repairing the MPFL with sutures has little role to play in this condition, as there is good evidence that this does not reduce the rate of subsequent dislocations. A ‘Reconstruction’ is performed whereby the gracilis tendon (small hamstring tendon) is fashioned into a ‘new’ MPFL. This ‘reconstruction’ can be performed in isolation, or combined with a ‘tibial tubercle osteotomy’ (see below).

A small incision is made on the upper inside of the shin bone, and the gracilis (small hamstring tendon) is removed. A second small incision is made on the inside of the kneecap and two ‘tunnels’ are created in the kneecap, to position the ends of the hamstring tendon. Finally, a small incision is made over the inner side of the end of the thigh bone (femur) and this hamstring tendon is secured into position using a screw.

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Patella dislocations can lead to early arthritis

Tibial Tuberosity Transfer

The most common bony procedure required to stabilise the patella

As part of the preoperative detailed assessment, you will undergo a specialised CT scan to check your bony anatomy. When your ‘Tibial tubercle’ is significantly mal-positioned, you will require an ‘osteotomy’ as part of your procedure. The purpose of this ‘osteotomy’ is to re-position the tubercle, and allow normal patella tracking. This procedure may be combined with a MPFL reconstruction (see above) in some situations. It is important to note that an isolated MPFL reconstruction is the most common procedure.

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An incision is made alongside the tibial tubercle. The patella tendon is protected, and using a small saw, the tuberosity is partially released. This allows for it to be translated across into a better position. Typically this is in the order of 10mm. The bone fragment (tubercle) is then held in its new position with the use of 2 screws.