Surgery For Recurrent Patella Dislocation

The patella, or kneecap, is a small bone that shields the knee joint, positioned in front of the knee within the trochlear groove where the femur and tibia meet.

Articular cartilage beneath the patella and at the femur’s end cushions and facilitates smooth gliding between bones during leg movement. Supporting this joint are various soft tissues, including the medial patellofemoral ligament (MPFL), which connects to the inner side of the patella, preventing it from slipping away from the knee. Damage to this ligament results in patellar dislocation.

Patellar dislocation occurs when the kneecap shifts out of the trochlea. Recurrent patellar dislocation happens when this occurs repeatedly. After two episodes, the risk of further dislocation rises to nearly 70% to 80%.

Symptoms

The common symptoms of recurrent patella dislocation are:

Pain in the knee and around the knee cap
Swelling
Knee instability
Feeling like it may dislocate again

Treatment

Non-surgical Treatment

If your kneecap has dislocated once or twice, conservative treatment may be recommended initially. The primary goal is to alleviate pain, typically achieved through medication and adhering to the PRICE protocol: Protecting the injured joint, Resting, applying Ice to the affected area, applying Compression, and Elevating the leg to reduce inflammation. Immobilization with a brace, cast, or splint for a limited period may also be advised. Additionally, your doctor may perform stretches to target the knee’s outer structures and recommend specific exercises to bolster muscle strength. Analgesics and nonsteroidal anti-inflammatory drugs may be prescribed to manage pain and reduce swelling.

Surgical Treatment

If non-surgical treatments fail to alleviate the symptoms of recurrent patella dislocation, surgery may be recommended. Realignment procedures typically begin with arthroscopy, a minimally invasive technique utilizing small incisions to access the affected area. Loose fragments may be removed during this process before proceeding to address the underlying factors contributing to dislocation.

Reconstruction of the torn medial patellofemoral ligament (MPFL) involves drilling small holes in the patella and femur, through which a segment of hamstring tendon is passed to replace the damaged MPFL. The tendon is secured in place using screws and anchors.

For cases involving a high-seated patella, surgical realignment is performed to properly position the patella within the femur’s groove. This entails repositioning the tibial tuberosity, a portion of the tibia, and securing it with screws until complete healing occurs.

Trochleoplasty, although less common, may be considered to deepen or reshape the groove at the lower end of the femur. This procedure involves removing bone and securing the patella in place using dissolvable sutures or nails.

Additionally, the surgeon may address tight or overstretched ligaments surrounding the kneecap by either lengthening or tightening them as needed.