Patellar Instability Surgery
What are the Surgical Options for Patellar Instability?
Surgical intervention is often necessary for patients with recurrent patellar instability, structural abnormalities, or failure of conservative management. Several surgical techniques are available to address patellar instability, each tailored to the underlying pathology and individual patient factors. This section provides a detailed overview of four common surgical procedures for patellar instability: Medial Patellofemoral Ligament (MPFL) Reconstruction, Tibial Tubercle Osteotomy (TTO), Distal Femur Osteotomy, and Trochleoplasty.
- Procedure: MPFL reconstruction involves the creation of a new ligament using autograft or allograft tissue to replace the torn or attenuated MPFL, restoring stability to the patellofemoral joint.
- Indications: MPFL reconstruction is indicated for patients with recurrent lateral patellar dislocations or subluxations due to MPFL insufficiency or injury.
- Technique: The surgical technique typically involves identifying the femoral and patellar insertion sites of the MPFL, preparing bony tunnels, and securing the graft in place using fixation devices such as anchors or screws.
- Rehabilitation: Postoperative rehabilitation focuses on protecting the graft, restoring knee range of motion, and gradually strengthening the quadriceps and surrounding muscles to optimize patellar stability.
- Procedure: TTO involves cutting and realigning the tibial tubercle, the bony prominence where the patellar tendon attaches, to alter the patellar tendon’s angle of pull and improve patellar tracking.
- Indications: TTO is indicated for patients with patellar instability associated with patellar alta (high-riding patella) or increased tibial tubercle-trochlear groove (TT-TG) distance.
- Technique: The surgical technique may involve performing a medial or lateral TTO, depending on the specific alignment issues and patient factors. The tibial tubercle is cut and shifted to a new position using specialized instruments and fixation hardware.
- Rehabilitation: Postoperative rehabilitation aims to protect the osteotomy site, restore knee range of motion, and gradually increase weight-bearing and functional activities as bone healing occurs.
- Procedure: Distal femur osteotomy involves cutting and realigning the distal part of the femur to correct angular deformities, such as valgus or varus alignment, that contribute to patellar instability.
- Indications: Distal femur osteotomy is indicated for patients with patellar instability associated with genu valgum (knock-knees) or genu varum (bow-leggedness) deformities.
- Technique: The surgical technique may involve a medial or lateral opening wedge osteotomy or a closing wedge osteotomy, depending on the desired correction and patient anatomy. Specialized plates or screws are used to stabilize the osteotomy site.
- Rehabilitation: Postoperative rehabilitation focuses on protecting the osteotomy site, promoting bone healing, and gradually restoring knee range of motion and strength.
- Procedure: Trochleoplasty involves reshaping the trochlear groove of the femur to deepen and stabilize the patellofemoral joint, improving patellar tracking and reducing the risk of dislocation.
- Indications: Trochleoplasty is indicated for patients with patellar instability associated with trochlear dysplasia (shallow trochlear groove) or other structural abnormalities of the trochlea.
- Technique: The surgical technique may involve various approaches, including a medial or lateral trochleoplasty, depending on the specific anatomical issues and patient factors. Bone resection, reshaping, and stabilization techniques are used to deepen and contour the trochlear groove.
- Rehabilitation: Postoperative rehabilitation aims to protect the trochleoplasty site, restore knee range of motion, and gradually increase weight-bearing and functional activities as the joint heals.
Why choose Dr. Christian Cruz?
For those needing surgical intervention for patellar instability, Dr. Christian Cruz provides expert care in Alexandria, Arlington, and Lanham. Using advanced surgical techniques, Dr. Cruz aims to restore stability and functionality to the knee. Contact us to learn more about your surgical options.
At a Glance
Dr. Christian Cruz
- Fellowship trained in Sports Medicine and Shoulder Surgery
- Expertise in complex knee and shoulder reconstruction
- Assistant Professor of Orthopaedic Surgery at Uniformed Services University School of Health Sciences
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