Surgery to stabilise the kneecap is usually only offered when physiotherapy hasn’t been successful. Options include medial patella-femoral ligament (MPFL) reconstruction, bony realignment surgery and trochleoplasty.
Surgical treatments for kneecap (patella) stabilisation include:
- Medial patella-femoral ligament (MPFL) reconstruction: The medial patellofemoral ligament is a broad structure located on the inside of the knee joint. It connects the kneecap (patella) to the thigh bone (femur). The primary purpose of the MPFL is to provide stability to the kneecap; it provides restraint to any movement toward the outside of the knee. MPFL reconstruction is surgery in which a new medial patellofemoral ligament is created to stabilise the knee and help protect the joint from additional damage in cases of serious and recurring dislocation of the kneecap. It offers an excellent treatment option for people who have experienced more than one dislocation. It can be carried out using a combination of keyhole surgery and minimally invasive open surgery. During the procedure, a single hamstring tendon is used to reconstruct the MPFL. The procedure involves making a small tunnel in the kneecap and a second tunnel where the original ligament attached to the thigh bone. The new ligament is then passed as a loop through the tunnel in the kneecap, through the tunnel in the thigh, and secured in position. In most cases, you’ll be able to go home the next day and you should be able to take your own weight, supported by crutches, in a week or two. You can expect to get back to your usual activities around three months after surgery. Professor Schoettle developed a new technique for reconstructing a damaged MPFL, which has become known as the Schoettle Point.
- Bony realignment surgery: if your kneecap instability is caused by having an abnormal anatomy, such as a kneecap that is in a higher position than normal (patella alta), you may be offered a bony realignment procedure. The amount of deformity and how much it needs to be corrected is calculated from an MRI or CT scan of the knee. This is called a TTTG measurement. The procedure involves detaching the kneecap tendon, together with a small block of bone to which it is attached, and moving it towards the midline. It is then fixed in its new position with screws. Most patients are able to go home the next day, with the knee immobilised in a brace. You’ll be able to gradually bear your own weight after around two weeks and by six weeks most patients are able to bear their own weight without using a brace
- Trochleoplasty: This is a surgical procedure to restore stability to the knee, alleviate pain and improve mobility if you have been diagnosed with trochlear dysplasia. The procedure reshapes the trochlea to allow the patella to move smoothly, preventing knee instability and pain. It may be performed arthroscopically (keyhole surgery using an arthroscope) which has a camera and a light at one end) or using open surgery. You may need further surgical procedures, such as ligament reconstruction, following your trochleoplasty. A programme of physiotherapy will help you to rehabilitate and regain movement in your knee. It normally takes around six months before you can resume more active sports.