Patella Stabilisation

Following dislocation of the patella generally treatment is conservative to strengthen the muscles which then maintains patella stability.  Sometimes however physiotherapy treatment alone is insufficient to maintain patella stability long-term.  In that case some form of patella stabilisation becomes necessary.

The exact procedure required depends on a number of factors as described within the patella dislocation section of conditions treated.  Surgery falls into either soft tissue stabilisation or bony stabilisation.

Bony stabilisation is required when there is altered alignment of the patellofemoral joint due to the position generally of the attachment of the patella tendon.  The position of the patella tendon in relation to the groove in relation to the groove in which the patella sits in the femur determines whether a soft tissue procedure or a bony procedure is required. 

In the case of a bony procedure generally this involves moving the attachment of the patella tendon to the tibia and then securing the attachment in the new position.

In the case of a soft tissue problem, this usually involves damage to the sheets of tissue adjacent to the medial border of the patella.  This is known as the medial patella retinaculum and contains a ligament call the medial patellofemoral ligament. 

Recently we have started to appreciate the damage to this ligament can result in patellar instability and with modern surgical techniques this ligament can be reconstructed using a hamstring tendon to provide a graft.  This procedure is known as medial patellofemoral ligament reconstruction.

In general terms this is carried out using an arthroscopy of the knee to ensure that the patella will track normally and then harvesting a hamstring tendon through a small incision below the knee and threading it between the attachment of the medial collateral ligament to the femur and through the patella to make a new ligament which will restore stability. 

You will have 3 small cut around the knee in addition to arthroscopy incisions.  Following surgery which is generally carried out as a day case you will be mobilised with the help of physiotherapy but it is usual to have difficulty bending the knee to start with because the knee feels tight.

Following surgery most patients require at least a week off driving and 2 weeks off work and are unable to bend the knee comfortably for at least 6 weeks following the operation. 

With intensive physiotherapy however the range of movement is gradually restored and this should be associated with a feeling of stability in the joint.  It takes nearly a year to reach an endpoint in recovery but in terms of returning to sport, you can start this after about 6 weeks after surgery but should avoid twisting sport for a total of 3 months. 

The consent information for this procedure can be found here.