Patella Realignment

What is Patella Realignment?

Patella realignment is surgery performed to improve the position and movement of the patella, commonly known as the kneecap. The procedure may be recommended when the kneecap does not move correctly within the groove at the front of the thigh bone.


The patella normally slides up and down within a V-shaped channel called the trochlear groove as the knee bends and straightens. This movement is known as patellar tracking. If the kneecap moves too far towards the outside of the knee, it may cause pain, instability, partial dislocation or complete dislocation.


Patella realignment is not one single operation. It is a general term covering several procedures that may adjust the bones, ligaments or other soft tissues around the kneecap. The procedure chosen depends on the cause of the abnormal tracking or instability.


Who is Suitable for Patella Realignment?

Patella realignment may be considered for people who have ongoing symptoms caused by abnormal patellar tracking or instability.


Suitable patients may include those with:

  • Repeated kneecap dislocations
  • Recurrent partial dislocations, known as subluxations
  • A kneecap that repeatedly moves towards the outside of the knee
  • Persistent pain at the front of the knee
  • Patellofemoral pain associated with abnormal alignment
  • A high-riding kneecap, known as patella alta
  • Abnormal positioning of the tibial tubercle
  • Damage to the cartilage underneath the kneecap
  • Difficulty participating in sport, work or everyday activities
  • Symptoms that have not improved with physiotherapy, bracing and activity modification


Recurrent instability can place the cartilage of the kneecap and trochlear groove at risk of further injury. Surgery may therefore be recommended to improve stability and reduce the chance of additional damage.


Patella realignment is generally not the first treatment offered after a single uncomplicated kneecap dislocation. Many first-time dislocations can initially be treated without surgery using physiotherapy, temporary bracing and a gradual return to activity.


Surgery is more likely to be considered when the kneecap continues to dislocate, significant structural abnormalities are present, or an injury has damaged bone or cartilage.


Benefits of Patella Realignment

The main goal of patella realignment is to improve how the kneecap moves within the trochlear groove.


Potential benefits include:

  • Improved kneecap stability
  • Reduced risk of further dislocation
  • Better patellar tracking
  • Reduced pain at the front of the knee
  • Improved confidence when walking, running or changing direction
  • Better ability to climb stairs, squat or exercise
  • Reduced strain on damaged areas of cartilage
  • Improved knee function
  • Greater ability to return to work, sport and recreational activities


Types of Patella Realignment

Tibial Tubercle Osteotomy

A tibial tubercle osteotomy involves cutting and repositioning the small section of bone at the upper front of the tibia where the patellar tendon attaches.


The bone may be moved in one or more directions:

  • Medialisation: The tibial tubercle is moved towards the inside of the knee to reduce outward tracking.
  • Anteriorisation: The tubercle is moved forwards to reduce pressure on the patellofemoral joint.
  • Anteromedialisation: The bone is moved both forwards and inwards.
  • Distalisation: The tubercle is moved downwards to treat a high-riding kneecap.


The repositioned bone is normally secured with screws while it heals. Tibial tubercle osteotomy may be used to treat patellar instability, painful malalignment, abnormal tracking and selected areas of cartilage damage.


Medial Patellofemoral Ligament Reconstruction

The medial patellofemoral ligament, or MPFL, is an important stabilising ligament on the inner side of the kneecap. It helps prevent the patella from moving too far towards the outside of the knee.


The ligament may become torn or stretched during a kneecap dislocation. MPFL reconstruction creates a new ligament using a tendon graft, which is attached to the patella and femur.


This procedure may be performed by itself when ligament damage is the main cause of instability. It may also be combined with bony realignment when both soft-tissue damage and abnormal bone alignment are present.


Trochleoplasty

Trochleoplasty reshapes or deepens an abnormally shallow trochlear groove. It may be considered in selected patients with severe trochlear dysplasia and recurrent patellar instability.


This is a more specialised operation and is generally reserved for significant structural abnormalities.


Soft-Tissue Realignment

Some procedures adjust the soft tissues surrounding the kneecap. This may include tightening stretched tissue on the inner side of the knee or carefully releasing excessively tight tissue on the outer side.


An isolated lateral release is now used selectively because it does not correct many of the common underlying causes of recurrent patellar instability.


Combined Procedures

More than one operation may be required. For example, a tibial tubercle osteotomy may be combined with MPFL reconstruction, cartilage repair or trochleoplasty.


The treatment plan is tailored to the individual rather than applying the same operation to every patient.


Alternative Options to Patella Realignment

Not everyone with kneecap pain or instability requires surgery.


Non-surgical treatment may include:

  • Activity modification
  • Physiotherapy
  • Quadriceps and hip strengthening
  • Balance and movement-control exercises
  • Patellar taping
  • A patella-stabilising brace
  • Weight management where appropriate
  • Pain-relieving medication
  • Anti-inflammatory medication when medically suitable
  • Gradual return to sport
  • Changes to training technique or footwear


Physiotherapy commonly focuses on strengthening the quadriceps, particularly the muscles that help control the kneecap, as well as the hip and gluteal muscles. Improving lower-limb control may reduce the tendency for the knee to fall inwards during movement.


For a first-time dislocation without major bone or cartilage injury, non-surgical treatment is often appropriate. Surgery may be discussed when instability continues despite rehabilitation or when imaging identifies a structural problem that is unlikely to improve with physiotherapy alone.


Preparation Before Patella Realignment

Before surgery, the orthopaedic surgeon will assess the knee and determine why the kneecap is not tracking correctly.


Assessment may include:

  • A review of previous dislocations and treatments
  • Examination of kneecap movement and stability
  • Assessment of leg alignment
  • X-rays
  • MRI scans
  • CT scans in selected cases
  • Measurements of patellar height and bone alignment
  • Evaluation of the cartilage and supporting ligaments


Patients should tell their surgical team about all prescription medicines, over-the-counter medicines and supplements they take. Some medications, particularly blood-thinning medicines, may need to be adjusted before surgery under medical guidance.


Smoking or vaping nicotine can delay bone and wound healing. Patients may be advised to stop well before surgery.


It is also important to prepare for the recovery period. This may involve arranging:

  • Transport home
  • Help with household tasks
  • Time away from work
  • Crutches
  • A knee brace
  • A safe place to rest
  • Follow-up physiotherapy


Patients should follow the hospital’s fasting instructions and any advice regarding showering, skin preparation and medications on the day of surgery.


Patella Realignment Surgery Procedure

Patella realignment is usually performed under a general anaesthetic. A regional nerve block may also be used to help control pain after surgery.

The exact steps depend on the procedure being performed.


During a tibial tubercle osteotomy, the surgeon makes an incision over the upper front of the shin. The tibial tubercle is carefully cut while keeping the patellar tendon attached. The section of bone is moved into the planned position and fixed using screws.


The surgeon checks the movement of the kneecap to confirm that it tracks more centrally within the trochlear groove.


If MPFL reconstruction is required, a tendon graft is prepared and secured between the inner side of the patella and the femur. The graft is tensioned carefully so that it stabilises the kneecap without making the joint excessively tight.


An arthroscopy may also be performed to inspect the cartilage, remove loose fragments or treat damage within the knee.


The operation may take approximately one to several hours, depending on its complexity and whether several procedures are combined.


Patella Realignment Recovery Plan

After surgery, the knee will usually be covered with dressings and may be placed in a brace. Pain relief and measures to reduce swelling will be provided.


Some patients can return home on the day of surgery, while others may remain in hospital overnight.


Weight-bearing instructions vary according to the procedure. Following a tibial tubercle osteotomy, crutches are generally required while the bone heals. The surgeon may limit the amount of weight placed through the leg for several weeks.


Early recovery may include:

  • Elevating the leg
  • Applying ice as advised
  • Taking prescribed pain relief
  • Wearing a knee brace
  • Using crutches
  • Performing circulation exercises
  • Beginning supervised knee exercises


Physiotherapy is an important part of recovery. Treatment normally progresses from controlling swelling and restoring movement to strengthening the quadriceps, hips and surrounding muscles.


Patients should not rush the rehabilitation process. The transferred bone must be given enough time to heal before higher-impact activities are introduced.


Return to desk-based work may be possible within several weeks, although this varies. Physically demanding work usually requires a longer recovery period.


Running, jumping and pivoting sports are introduced gradually once bone healing, strength, movement and knee control are satisfactory. Full recovery commonly takes several months and may take longer following combined procedures.


Patella Realignment Prognosis

Many appropriately selected patients experience improved kneecap stability and better function following patella realignment.


The outcome depends on:

  • The cause of the instability
  • The degree of abnormal alignment
  • Existing cartilage damage
  • The type of surgery performed
  • Bone healing
  • Muscle strength
  • Participation in rehabilitation
  • Previous knee operations
  • The patient’s activity goals


Surgery can substantially reduce the likelihood of further dislocation, but it cannot guarantee that the knee will feel completely normal.


Pain caused by instability or abnormal pressure may improve. However, longstanding cartilage damage or arthritis can continue to cause symptoms even when kneecap alignment has been corrected.


Maintaining muscle strength and following the rehabilitation program are important for achieving the best possible outcome.


Patella Realignment Risks

As with any operation, patella realignment carries potential risks.


These may include:

  • Infection
  • Bleeding
  • Blood clots
  • Anaesthetic complications
  • Wound-healing problems
  • Knee stiffness
  • Ongoing pain
  • Swelling
  • Numbness around the incision
  • Weakness of the quadriceps
  • Continued patellar instability
  • Overcorrection or undercorrection
  • Fracture of the tibia or patella
  • Delayed bone healing
  • Failure of the osteotomy to heal
  • Irritation from screws or other fixation devices
  • Need for later removal of screws
  • Graft stretching or failure
  • Damage to cartilage, nerves or blood vessels
  • Development or progression of arthritis
  • Need for further surgery


Tibial tubercle osteotomy involves cutting bone, so recovery and complication risks differ from those of an isolated soft-tissue procedure. A fracture can occasionally occur around the osteotomy site, particularly if excessive force is placed through the leg before the bone has healed.


Patients should seek medical advice promptly if they develop increasing pain, marked swelling, wound discharge, fever, calf pain, chest pain or shortness of breath after surgery.


What if Patella Realignment is Delayed?

Not every delay in surgery will cause permanent harm. Many patients can manage their symptoms temporarily with physiotherapy, bracing and activity modification.


However, repeated subluxations or dislocations may cause further injury to the cartilage on the underside of the kneecap or within the trochlear groove. Loose pieces of cartilage or bone may also develop following a dislocation.


Urgent assessment may be required when a dislocation is associated with a large amount of swelling, inability to move the knee, suspected fracture or a loose piece of bone or cartilage.


An orthopaedic surgeon can explain whether continued non-surgical treatment is reasonable or whether delaying surgery may increase the risk of further damage.


FAQs about Patella Realignment

How long does recovery take after patella realignment?

Recovery varies depending on the type of surgery performed. Many patients use crutches and a knee brace for several weeks. Physiotherapy is usually required to restore knee movement, strength and control. A return to running, jumping and pivoting sports may take several months, and full recovery can take six months or longer after more complex procedures.


Will I need a knee brace after patella realignment?

A knee brace is commonly used after patella realignment surgery, particularly following a tibial tubercle osteotomy or ligament reconstruction. The brace helps protect the knee while the bone or soft tissues heal. The surgeon will advise how long the brace should be worn and when knee movement can be gradually increased.


Can the kneecap dislocate again after surgery?

Patella realignment can significantly reduce the risk of another dislocation, but no operation can guarantee that instability will never return. The outcome depends on the cause of the instability, the procedure performed, the condition of the cartilage and participation in rehabilitation. Maintaining good quadriceps and hip strength may help protect the knee.


When can I return to work after patella realignment?

People with desk-based jobs may be able to return to work within a few weeks, depending on pain, swelling and mobility. Jobs involving prolonged standing, lifting, climbing or physical activity generally require a longer recovery period. The surgeon and physiotherapist can provide advice based on the type of work performed and the progress of healing.


Are the screws removed after patella realignment?

The screws used during a tibial tubercle osteotomy are often left in place permanently. However, some patients notice discomfort or irritation over the screws, particularly when kneeling. If the bone has healed fully and the screws are causing symptoms, they may be removed during a separate minor procedure.

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