Patellofemoral Stabilisation 

 

WHAT IS PATELLOFEMORAL KNEE STABILISATION SURGERY?

 Patella stabilisation surgery also known as patella realignment is a surgical procedure to stabilise and realign the patella following subluxation, dislocation and subsequent misalignment of the knee cap during movements. Physiotherapy plays a crucial role in rehabilitation and recovery following patella stabilisationsurgery. 

The patella (kneecap) is a small, floating, sesamoid bone located at the front of the knee. The patella is one of three bones along with the thigh bone (femur) and shin bone (tibia) that make up the knee joint. The patella is embedded in the quadriceps tendon at the front of the knee and functions as a pulley for the quadriceps to help create more power during movements of the knee. 

Patella stabilisation is a surgical procedure used in the treatment of conditions such as patella subluxation and patella dislocation. 

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PATELLA SUBLUXATION

In a normal knee, the patella glides up and down within a groove at the bottom of the thigh bone (femoral groove or trochlea) during movement. Weakening of the muscles that hold the patella in its correct position within the femoral groove causes instability of the kneecap. Instability can cause the patella to be pulled out of the femoral groove and towards the outer side of the knee known as patella subluxation. Patella subluxation causes maltracking of the patella resulting in significant discomfort and irritation at the front of the knee during knee movements. 

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PATELLA DISLOCATION

 A dislocation of the patella occurs when the knee cap comes completely out of its groove and rests on the outside of the knee joint. Kneecap dislocation results from patella instability. Often, when the kneecap has dislocated for the first time, ligaments that were holding the kneecap in position are torn. The most common ligament that is torn as a result of knee dislocation is the medial patellofemoral ligament (MPFL). Knee dislocation and tearing of the MPFL causes the patella to be out of its correct position and therefore fails toglide up and down its femoral groove properly (maltracking). Maltracking of the patella causes a considerable amount of pain and irritation at the front of the knee during movement. 

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POST OPERATIVE CARE

In general, postoperative care instructions and recovery after patellofemoral stabilisation surgery will involve the following steps:​

• You may notice some pain, swelling, and discomfort in the knee area. Pain and anti-inflammatory medications are provided as needed.

• Antibiotics are prescribed as needed to address the risk of surgery-related infection.

• Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.

• You will be placed on crutches for the first few weeks with instructions on restricted weight-bearing. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.

• You are advised to keep your leg elevated while resting to prevent swelling and pain.

• Refrain from smoking as it can negatively affect the healing process.

• Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.

• Refrain from strenuous activities and lifting heavy weights for the first couple of months. Gradual increase in activities over a period of time is recommended.

• An individualized physical therapy protocol is designed to help strengthen your knee muscles and optimize knee function.

• You will be able to resume your normal activities in a couple of months; however, return to sports may take 6 months or more.

• Refrain from driving until you are fully fit and receive your doctor’s consent.

• A periodic follow-up appointment will be scheduled to monitor your progress.

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RISKS AND COMPLICATIONS

Patellofemoral stabilisation is a relatively safe procedure; however, as with any surgical procedure, it does carry some risks and complications, including:

• Persistent pain

• Blood clots

• Infection

• Bleeding

• Anesthetic/allergic reactions

• Injury to nerves and blood vessels

• Loss of ability to extend the knee

• Recurrent dislocations or subluxations

• Arthrofibrosis (thick fibrous material around the joint)

• The need for revision surgery

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