Background
Patella or “Knee-cap” instability is a common cause of knee pain and functional impairment that can impacts a person’s ability to confidently perform activities. There are a number of factors that can predispose to patella instability ranging from normal variations in anatomy to injury and trauma. Patella problems exist along a spectrum ranging from patella mal-tracking to recurrent dislocations. Most patients describe a sense of apprehension during daily activities which is often exacerbated with more vigorous pursuits including sport.
Indications
Anatomical variations predisposing to patella mal-tracking manifest as pain and mechanical symptoms (clicking, catching sand subluxation). If left untreated this can result in accelerated knee arthritis, particularly behind the knee cap, and decreased function. More extreme forms can result in patella subluxation (movement) or even dislocation (out of place). A patella dislocation will usually result in a very swollen knee which will take some weeks to settle down. Following the initial instability episode the patella is more likely to dislocate in the future. Recurrent instability often requires surgical stabilisation if unable to be controlled with strength and rehabilitation programs.
Treatment/Pathology
Depending on the cause of your patella instability (i.e. anatomy, physiology Vs trauma and injury) there are specific treatments aimed at restoring stability to your knee. Most patients have previously trialed and subsequently failed forms of non-operative management (e.g. strapping, bracing) and are seeking a surgical solution to their problem.
Dr Anderson will carefully examine your knee and overall lower limb alignment to determine the underlying cause of your patella instability and/or mal-tracking and in most cases will refer you for relevant imaging to help plan your management.
Surgical Detail
Patella realignment (or stabilisation) surgery is aimed at restoring the normal movement of the knee joint and allows you to return to your activities with confidence. The type of surgery (either bone, soft tissue or combined) will be determined based on the underlying problems identified during your consultation(s) and follow-up imaging. The procedure is performed under general anaesthetic via a number of small incisions around the knee based on the condition(s) that is being treated. The knee is routinely immobilised in a brace or splint after surgery for your comfort and to protect the repair.
Post-Operative/Recovery
Patients typically spend one night in hospital to monitor pain and swelling. A physiotherapist will meet you the following day to commence your rehabilitation before being reviewed for discharge by Dr Anderson. Your 2-week review includes a wound check and a chance to monitor your recovery. Ongoing follow-up and supervised rehabilitation is important to ensure a successful outcome.
Key Points
Debilitating knee pain
Subluxation/Dislocation (i.e. instability)
Malalignment Vs Injury