Patella Stabilisation Procedures

If your patella feels unstable or is regularly dislocating this can often be improved by strengthening your core together with the muscles around the knee using physiotherapy including Pilates. If this does not provide significant improvement for you, I can perform surgical procedures such as reconstruction of the medial patellofemoral ligament (MPFL), possibly combined with a tibial tubercle osteotomy (TTO) to help improve the stability of your patella.

Dislocation of the patella (kneecap) is often a painful, frightening experience, and often leads to patients feeling that they do not trust their knee in day to day activities.

The medial patellofemoral ligament (MPFL) is the main ligament that stabilises the patella (kneecap) as it progresses through a range of movement.

As you bend and straighten your leg, the patella glides in a groove at the end of your thigh bone (femur) known as the trochlear groove of the femur. Sometimes the patella can come out of the groove, with or without an injury to the knee. This can lead to ongoing recurrent patella instability, with a feeling that the patella may slide out of the groove when the knee moves (subluxations) or complete dislocations. This may be painful as it causes scuffing (wear) to the under-surface of the patella and may lead to the development of osteoarthritis.

MPFL reconstruction is indicated in cases of recurrent patella instability episodes, where physiotherapy fails to provide adequate symptom control.

I perform MPFL reconstruction using minimally invasive techniques, with one of your hamstrings tendons (semi-tendinosis) providing the graft. The graft is anchored onto the patella and placed into a tunnel in your femur, to act as a check rein to stop the kneecap dislocating laterally. During the procedure I use knee arthroscopy: to ensure any damage to the knee is treated, and to place the graft under correct tension to ensure satisfactory patella tracking. The operation is generally performed as a daycase procedure under general anaesthetic, with a nerve block to help with pain.

MPFL reconstruction is often highly successful in providing patients with a stable knee, provided patients engage with specific patellofemoral physiotherapy in the post-operative period. More frequently in my practice the procedure is often combined with Tibial Tubercle Osteotomy (TTO) if the patella is sitting too high.

MPFL Reconstruction

The patella attaches to the top of your shin bone (tibia), via your patella tendon, at a specific attachment point called the tibial tubercle.

A TTO procedure involves bringing the kneecap down into the groove, by detaching the tendon where it attaches on the shin bone (tibia), using a domino sized piece of bone, and securing this lower down the leg with a combination of plates and screws. There is a chance that the plate and screws may need to be removed at a later date. The operation is generally performed as a daycase procedure under general anaesthetic, with a nerve block to help with pain.