Kneecap (Patellar) Instability: Treatment Options

Kneecap (Patellar) Instability: Treatment Options

Having a loose or unstable kneecap can be a result of a one-time acute dislocation, or it could be from a more chronic condition where the kneecap easily dislocates over and over. Either way, letting it go untreated can lead to arthritis of the kneecap and the groove, causing increased pain and limited movement.

If the arthritis under the kneecap is bad enough but the rest of the knee looks healthy, the patient may benefit from a partial knee replacement. This is a special scenario and should be discussed with the orthopedic provider.

One of the main ways to help prevent getting a kneecap dislocation in the first place is strengthening the muscles of the leg. Strength in the leg can help keep the leg stable during activity and help prevent the twist in the knee that causes a kneecap dislocation. Having a good balance of quadriceps, hamstring, and hip muscle strength is the key.

However, if the patient has dislocated their kneecap from a single injury, the orthopedic provider may suggest trying nonoperative treatment. This would start with the R I C E method or rest, ice, compression, and elevation of the knee to bring down the pain and swelling. Special braces, taping methods, and simply avoiding the activities that cause pain can help decrease symptoms as well.

Other treatments include non-narcotic medications like anti-inflammatory medicine, and physical therapy to increase strength and movement. There are also different types of injections that can be done in the knee if the provider thinks they will help. Depending on the patient and their injury, they may be able to avoid surgery with the goal of getting back to their normal activities within a few months.

Patients that have recurrent or repeated kneecap dislocations may be better treated with surgery. The type of surgery performed will depend on why the kneecap is dislocating in the first place. If surgery is needed because a patient had a severe one-time dislocation, the surgeon may recommend a reconstruction of the medial patellofemoral ligament, or M P F L. A tendon graft would likely be used, taken either from the patient or from a cadaver, and would be fixed onto the inside of the kneecap and inside of the thigh bone, helping to keep the kneecap from dislocating again.

If the dislocations are happening because the patient's q angle is too big, then knee alignment is the issue. There is a procedure that shifts a piece of the shin bone over where the patellar tendon attaches. By moving the attachment point, the kneecap is more lined up in the groove and can help prevent further dislocations.

Some patients have a poorly shaped groove and that is the reason for their kneecap instability. This procedure reshapes the groove, turning it into a normal v, so the kneecap stays in the middle and does not fall off the edge. Some patients may have more than one of these issues causing their kneecap to dislocate, so sometimes more than one of these procedures is done at the same time during surgery.

Following surgery, crutches are needed for a few weeks and some type of brace will be used to help protect the knee while it heals. Patients will begin physical therapy to regain motion and strength, and after a few months, a smaller brace can be used to help the patient get back to daily activity. Depending on the surgery, it may take anywhere from 6-9 months to resume full activity, like mountain biking, running, and sports.