Patellar Stabilization
Background
Patellar instability occurs when the patella (kneecap) slips partly or completely out of the thighbone groove, usually toward the outside of the knee. Repeated episodes can cause pain, limit activity, and damage the cartilage. The medial patellofemoral ligament (MPFL) is an important restraint that helps keep the kneecap from shifting outward. It is commonly injured during a patellar dislocation.
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The surgical plan is tailored to the reason the kneecap is unstable. An MPFL reconstruction may be sufficient on its own. When the position of the patellar tendon attachment contributes substantially to poor tracking, a tibial tubercle osteotomy (TTO) may be added to move that attachment and improve alignment.
The Surgical Procedure
Patellar stabilization is performed under general anesthesia, often with a nerve block to help control pain. The procedures performed depend on your examination and imaging, as well as any cartilage or other injuries found in the knee.
MPFL Reconstruction
The injured MPFL is replaced with a tendon graft. The graft is secured to the kneecap and thighbone to provide a new restraint against outward displacement. Its position and tension are carefully checked so the kneecap remains stable while moving naturally through the groove.
Tibial Tubercle Osteotomy
The tibial tubercle is the bony attachment of the patellar tendon on the shinbone. During a TTO, this portion of bone is moved to a position that improves kneecap tracking and secured with screws while the bone heals. Depending on the anatomy, it may be moved inward, downward, or slightly forward. A TTO can be performed together with an MPFL reconstruction when both soft tissue stability and alignment need to be addressed.
Additional Procedures
If a dislocation has caused a loose cartilage or bone fragment, that injury may be treated during the same surgery. Cartilage damage and other findings are assessed individually and may affect the rehabilitation plan.
Recovery Timeline
Recovery depends on whether an MPFL reconstruction is performed alone or combined with a TTO or cartilage procedure. A TTO generally requires more protection because the bone must heal as well as the ligament graft.
Early Recovery (Weeks 1 - 6)
The main goals are to protect the reconstruction, control swelling, and regain safe knee motion.
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A brace and crutches are used during early recovery.
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Physical therapy begins with motion within the allowed limits and exercises to reactivate the quadriceps.
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Weight-bearing instructions depend on the procedure. A TTO typically requires a longer period of protected weight bearing than an isolated MPFL reconstruction.
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Follow-up X-rays may be used after a TTO to assess bone healing.
Intermediate Recovery (Weeks 6 - 12)
As permitted, you will gradually increase weight bearing, restore your walking pattern, and work toward full knee motion. Strengthening focuses on the quadriceps, hip, and core.
Late Recovery (Months 3 - 6)
Therapy progresses to more demanding strength, balance, and movement exercises. Running and jumping are introduced when knee motion, strength, control, and, if applicable, bone healing are sufficient.
Return to Sport (Months 6 - 9 and Beyond)
Sport-specific drills progress toward full participation. Clearance depends on knee stability, strength, movement quality, confidence, and the demands of the sport. Recovery may take longer after a combined procedure or treatment of a cartilage injury.
What to Expect
Pain Management
We utilize a multimodal approach including a nerve block when appropriate, oral medications, and ice therapy to minimize the postoperative pain and to limit narcotic use. Swelling and discomfort are expected early on, but most patients find their pain very manageable with this comprehensive approach.
TTO Healing
If a TTO is performed, your weight-bearing and activity restrictions protect the bone while it heals. Feeling stronger does not necessarily mean the osteotomy is ready for impact activity. Progression also depends on follow-up assessment of bone healing.