Patellar Stabilization

Non-surgical management is often the first-line treatment for patellar instability when no bone or cartilage damage is damaged. This successfully treats most people with patellar instability and should provide rapid functional recovery and minimize recurrent dislocations.

Conservative management includes:

• Physical Therapy: Strengthening exercises focused on the muscles around the knee, especially the quadriceps, can help stabilize the patella.
• Bracing or Taping: Knee braces or patellar taping can provide additional support and help maintain the patella in the correct position.
• Activity Modification: Avoiding activities that worsen the symptoms may help manage the condition without surgery.

Surgical options are considered when conservative management fails to provide relief or in cases of repeated patellar dislocation. Surgical procedures aim to correct the alignment and improve the stability of the patella. The type of surgery is determined based on the specific anatomical and functional abnormalities present. Various procedures include:

1. Medial Patellofemoral Ligament (MPFL) Reconstruction: This procedure involves reconstructing the MPFL, a key ligament for patellar stability that often gets damaged during dislocation. A graft, made from either the patient’s tendon from a different part of the knee (autograft) or a donor tendon (allograft), is used to recreate the ligament and reattach it to the correct anatomical locations on the patella and femur. Sometimes, a repair of the MPFL ligament is done instead.
2. Tibial tubercle osteotomy: This surgery is indicated when the trochlea groove is not aligned with the front of the tibia. It involves cutting and moving the tibial tubercle (the bony attachment of the patellar tendon on the tibia) so that it is more in line with the trochlea (the groove on the femur where the patella glides). This improves patella tracking and stability.
3. Lateral release or lengthening: This procedure involves releasing or lengthening tight lateral structures to decrease the excessive lateral pull on the patella. It is typically performed in combination with other patellar stabilizing surgeries.
4. Trochleoplasty: In cases where the shape of the trochlear groove is very abnormal, trochleoplasty can be performed to deepen the groove and improve patellar tracking. This is a complex procedure reserved for select cases.
5. Cartilage restoration: Cartilage restoration addresses cartilage damage that can occur with patellar dislocations. The primary goal is to restore the integrity of the patella’s cartilage surface. In conjunction with cartilage restoration, other surgical interventions, such as those listed above, may be required to stabilize the patella.

Patellar stabilization surgery is an effective method of treating patellar instability. It improves the knee’s stability, prevents further cartilage and bone damage, and allows the patient to return to activities.

Postoperative rehabilitation is crucial for a successful outcome. It involves a gradual progression through phases of physical therapy, starting with a range of motion exercises, then strengthening, and eventually returning to normal activities and sports. The specific timeline and protocols may vary depending on the surgical procedure and individual goals.