Patellar Instability Treatment Options

Can patellar instability be treated without surgery?

In acute cases of instability, including the first injury to the MPFL or LPFL, conservative treatment may be recommended. This includes physical therapy to restore strength and mobility, as well as the temporary use of a knee brace. Conservative treatment with a period of immobilization followed by physical therapy can be beneficial in some patients depending on their underlying predisposing factors. However, despite conservative treatment, recurrent dislocations can still occur. Even without recurrent dislocations, persistent problems, disability, and arthritis can be present. Thus, MPFL or LPFL reconstruction may be offered early to prevent these consequences when a patient has recurrent dislocations.

What are the surgical options for patellar instability?

Treatment for chronic knee instability is focused on correcting the underlying cause. The goal is to restore stability. Surgical treatment options are based on the cause of the chronic instability.

• When instability is caused by complex issues like a ligament tear or laxity, surgical reconstruction of the MPFL or LPFL will be recommended to enable the kneecap to track properly and remain in its groove. (Image 1)
• When there is a misalignment of the bones, a surgical procedure called an osteotomy may be recommended to realign the bones and prevent future dislocations. (Image 2)
• When there is a big jump of the knee cap a surgery called trochleoplasty may need to be performed (Image 3)
• When there is cartilage damage, surgery to reposition the kneecap and give it more space to move with respect to the femur can improve the pain.
• If needed, knee arthroscopy and cartilage restoration procedures can help by stabilizing fragments of cartilage that might be loose.

How long is the recovery after MPFL/LPFL Reconstruction?

Initially following patellar instability surgery, you will be allowed to bear full weight on the operative leg using crutches as tolerated by pain. You will be required to wear a hinged knee brace for 6 weeks following surgery. Initially, this brace will be locked straight. Physical therapy will begin immediately following surgery, and you will be allowed to gradually progress the range of motion of the operative knee over a period of 6 weeks per Dr. Chahla’s MPFL/LPFL reconstruction post operative protocol. Physical therapy is a crucial part of the recovery process to regain strength and mobility. Full recovery can take 4-7 months following surgery.