Patella dislocation stabilisation surgery with Dr. Alexey Borshch

This page is general information intended for patients of Dr. Borshch. Your situation may be different, so please follow the advice of your surgeon and treating team.

The patella (kneecap) sits in a groove at the front of the knee and helps the thigh muscles straighten the leg.  When it is NOT in the groove, it is naturally loose (you can feel your kneecap move easily from side to side when your knee is straight and the muscles relaxed).  There are many anatomical structures about the knee that help guide the kneecap into its groove during motion, but when some of these structures are damaged or out of alignment, the kneecap can become unstable and slip partially (subluxation) or completely (dislocation) out of this groove—most often to the outside of the knee.

Patella stabilisation surgery refers to a group of procedures designed to:

• prevent the kneecap from dislocating or slipping
• improve confidence and function of the knee

The exact surgery performed depends on the cause of instability and your individual anatomy.

Patella stabilisation surgery is usually considered when there is recurrent patellar instability, especially after appropriate non-surgical treatment has been tried.

Common reasons include:

• Torn or loose Medial Patello-femoral Ligament (MPFL), which is supposed to guide the patella into the groove as the knee goes from extension to flexion.
• Long patellar tendon with a kneecap that sits higher than usual above the knee (far away from the groove).
• Tight lateral retinaculum, which is tissue on the outer part of the kneecap that keeps it abnormally far to the outside.
• Rotation of the patellar tendon to the outside, called a high Tibial tubercle to Trochlear groove distance, which predisposes the kneecap to to move to the outside of the knee.
• Shallow groove or flat kneecap.
• Weakened Quadriceps muscle either due to large distance from the kneecap or atrophy due to pain or apprehension.  Especially the Vastus Medialis part of the muscle which tends to keep the kneecap closer to the inside of the knee.

Physiotherapy is usually the first line of treatment and surgery is not usually recommended after a first-time dislocation unless there are specific high-risk features such as associated fractures. (https://pubmed.ncbi.nlm.nih.gov/34604425/)

Good preparation improves recovery and outcomes.

• Stop smoking/vaping if possible (smoking impairs healing).
• Maintain good general health and nutrition.
• Tell the team about any medical conditions or medications.

Pre-operative physiotherapy focuses on:

• reducing swelling
• improving knee movement
• strengthening the quadriceps and hip muscles

Better muscle control before surgery often leads to better results afterward.

• Arrange help for the first 1–2 weeks.
• Prepare for temporary use of crutches and a brace.
• Set up space for icing, exercises, and leg elevation.

Your team will advise which medications to stop or continue before surgery.

• Patella stabilisation surgery is often performed as an overnight stay surgery.
• Pain is managed with a multimodal pain relief plan.
• You will usually go home with a brace and crutches.

• The brace is worn to protect the repair and control knee movement.
• Weight-bearing may be limited or protected, depending on the procedure.
• Physiotherapy focuses on swelling control, gentle movement, and muscle activation.
• Driving is usually not safe until you can comfortably control the leg and are off strong pain medications.

• Gradual increase in knee movement and strength.
• The brace is progressively weaned.
• Walking and daily activities continue to improve.

• Advanced strengthening and balance training.
• Sport-specific drills may begin under physiotherapy supervision.

• Return to pivoting or contact sports once strength, control, and confidence have fully returned.
• Timing varies depending on the procedures performed and individual progress.

Most patients experience significant improvement in stability and a reduction in dislocation episodes after patella stabilisation surgery.

MPFL reconstruction in particular has shown low redislocation rates and good functional outcomes when performed for the correct indications. (https://pubmed.ncbi.nlm.nih.gov/35616703/)

Reducing repeated dislocations helps protect the cartilage of the kneecap and groove, potentially lowering the risk of long-term arthritis.

Contact our office, your GP, or seek urgent care if you notice:

• increasing redness, warmth, or swelling around the wounds
• worsening pain after initial improvement
• discharge or pus
• fevers or feeling unwell

(Infection after patella stabilisation surgery is uncommon.)

• calf pain or tenderness
• increasing swelling in one leg
• sudden shortness of breath or chest pain (call emergency services)

• difficulty bending or straightening the knee despite physiotherapy
• early review can help prevent long-term stiffness

• feelings of the kneecap slipping or giving way
• pain or swelling during twisting activities