Patellar Instability Treatment Options
Patellar instability treatment depends on the nature and severity of the condition, as well as the patient’s individual circumstances. In cases of acute patellar instability, especially during the first medial patellofemoral ligament (MPFL) injury, conservative management may be recommended. This approach typically includes physical therapy to enhance strength and mobility, along with the temporary use of a knee brace to provide support.
For first-time instances of patellar dislocation or subluxation, a non-surgical approach may be effective. This treatment plan generally involves a short period of immobilization to allow the affected ligament to heal, followed by a structured physical therapy program aimed at restoring joint function, stability, and muscle strength. Physical therapy exercises focus on strengthening the quadriceps, hamstrings, and hip muscles to support the knee and improve its tracking.
The use of a knee brace can help keep the kneecap in place and prevent additional dislocations during the early stages of healing. While conservative treatment can be beneficial for some patients, outcomes can vary depending on individual risk factors. In some cases, this approach may lead to recurrent dislocations or persistent knee issues, such as pain and joint instability. These complications may increase the risk of developing arthritis over time.
MPFL reconstruction may be recommended for patients who experience recurrent patellar dislocations or chronic knee instability, especially if conservative treatment has failed to provide lasting relief. MPFL reconstruction is a surgical procedure that rebuilds the medial patellofemoral ligament to help the patella track correctly within its groove, thereby reducing the risk of future dislocations.
Reconstruction of the MPFL is often suggested early in cases where recurrent dislocations have already occurred, to prevent further damage and long-term complications. This proactive approach can reduce the risk of chronic pain, cartilage damage, and the eventual onset of arthritis. The procedure involves using a tendon graft, either from the patient’s own tissue or from a donor, to reconstruct the MPFL and restore knee stability.
For patients with chronic patellar instability, treatment focuses on correcting the underlying issues contributing to the problem. The primary goal is to restore stability and improve the knee’s function. Surgical options are determined based on the root causes of the instability, such as ligament laxity, bone misalignment, or cartilage damage.
Surgical Reconstruction
When chronic instability is due to a torn or lax MPFL, surgical reconstruction is often necessary to reestablish proper patellar tracking. MPFL reconstruction strengthens the connection between the patella and the femur, enabling the kneecap to move smoothly within its groove during activity.
Osteotomy for Bone Realignment
In cases where patellar instability is linked to bone misalignment, a surgical procedure known as an osteotomy may be performed. This involves cutting and realigning the tibia or femur to adjust the position of the knee joint, which helps prevent the kneecap from dislocating in the future.
Cartilage Repair and Restoration
If cartilage damage is present, procedures aimed at restoring and stabilizing the cartilage may be necessary. Knee arthroscopy can be used to remove or repair loose fragments, while advanced cartilage restoration techniques can promote healing and improve joint function. These procedures can help alleviate pain and prevent further damage by ensuring the patella has adequate space to move without friction.
Following any surgical intervention for patellar instability, a comprehensive rehabilitation program is essential for optimal recovery. Most patients will need to use crutches for a few weeks after surgery to minimize weight-bearing on the affected leg and allow the surgical site to heal properly. During this period, wearing a knee brace may also be advised to provide additional support and stability.
Physical therapy is a critical component of post-surgical recovery, focusing on regaining joint mobility, rebuilding muscle strength, and enhancing balance. The rehabilitation process typically includes a range of motion exercises, strengthening routines for the quadriceps and surrounding muscles, and progressive weight-bearing activities. Patients are gradually introduced to more intensive exercises and sport-specific drills as they recover.
The timeline for returning to normal activities, including sports, varies based on the type of surgery performed and the patient’s adherence to their rehabilitation plan. Most patients can expect to return to physical activities within 4 to 7 months post-surgery, although this may vary depending on the complexity of the treatment and the individual’s healing process. Consistent follow-up with the orthopedic team ensures that recovery stays on track and that any potential complications are addressed promptly.
Patellar instability, whether acute or chronic, requires a tailored approach to treatment. While conservative methods like physical therapy and bracing can be effective for initial or mild cases, surgical intervention, such as MPFL reconstruction or osteotomy, may be necessary for more severe or recurrent cases. Addressing the underlying causes of instability is key to achieving long-term knee stability and preventing further complications. With proper treatment and a well-structured rehabilitation plan, most patients can return to their normal activities and maintain an active lifestyle.
Orthopedic surgeon Dr. Mark Cinque is a sports medicine surgeon in San Diego, California who specializes in the treatment of complex knee injuries. He has spent time training at The Steadman Clinic and Stanford Orthopaedic Surgery. He has published over 100 peer-reviewed manuscripts and has presented research internationally. He uses minimally invasive arthroscopic procedures to preserve the natural joint and reduce recovery time to accelerate his patients’ return to the activities they love.
At a Glance
Mark Cinque, MD
- Board-certified, fellowship-trained orthopedic surgeon
- Orthopedic Residency: Stanford University, Fellowship: The Steadman Clinic
- Authored over 100 peer-reviewed publications
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