Kneecap (Patellar) Instability: Treatment Options

Kneecap (Patellar) Instability: Treatment Options

Kneecap instability may occur after a single traumatic dislocation or as a chronic condition in which the kneecap repeatedly dislocates. When left untreated, this instability can lead to arthritis of the kneecap and the groove it travels in, resulting in increasing pain and limited motion over time. In rare cases where arthritis is isolated to the kneecap while the rest of the knee remains healthy, a partial knee replacement may be considered and should be discussed with an orthopedic provider.

One of the most effective ways to prevent kneecap dislocation is strengthening the muscles of the leg. Balanced strength of the quadriceps, hamstrings, and hip muscles helps stabilize the knee during activity and reduces the twisting forces that can cause the kneecap to dislocate.

For patients who experience a first-time kneecap dislocation, nonoperative treatment is often recommended. Initial management typically includes the RICE method—rest, ice, compression, and elevation—to reduce pain and swelling. Bracing, taping, activity modification, anti-inflammatory medications, and physical therapy may also be used to improve strength and motion. In many cases, these measures allow patients to return to normal activities within a few months without surgery.

Patients with recurrent kneecap dislocations are more likely to benefit from surgical treatment. The type of surgery depends on the underlying cause of instability. If instability results from ligament injury, reconstruction of the medial patellofemoral ligament, or MPFL, may be performed using a tendon graft from the patient or a cadaver to help prevent future dislocations.

In cases where instability is caused by abnormal knee alignment, such as an increased Q angle, a procedure may be performed to shift the attachment point of the patellar tendon on the shinbone. This realignment improves kneecap tracking within the groove. Some patients have a shallow or misshapen groove, which may require reshaping to better contain the kneecap. When multiple factors contribute to instability, more than one procedure may be performed during the same surgery.

After surgery, patients typically use crutches for several weeks and wear a brace to protect the knee as it heals. Physical therapy begins early to restore motion and strength, followed by gradual return to daily activities with a smaller brace. Depending on the procedure performed, full return to high-level activities such as running, biking, or sports may take six to nine months.