Patellar dislocation can result in significant pain, swelling, and difficulty bearing weight on the affected leg. In some cases, the patella may spontaneously relocate (reduce) after the initial dislocation, while in other instances, it may remain dislocated, requiring prompt reduction by a healthcare professional.

Initial treatment involves immobilization, ice application, and pain management. Depending on the severity, associated injuries, and underlying risk factors, further management may include physical therapy, bracing, or surgical intervention, such as medial patellofemoral ligament (MPFL) reconstruction, tibial tubercle osteotomy, or trochleoplasty.

Prompt diagnosis and appropriate treatment are essential to prevent recurrent instability, minimize the risk of complications like patellofemoral osteoarthritis, and facilitate a successful recovery and return to normal activities.

MPFL reconstruction

The medial patellofemoral ligament (MPFL) is a key static stabilizer of the patella (kneecap), preventing excessive lateral displacement or dislocation. MPFL reconstruction is a surgical procedure performed to treat recurrent patellar instability or dislocation, often in patients with predisposing factors such as trochlear dysplasia, increased tibial tubercle-trochlear groove (TT-TG) distance, or generalized ligamentous laxity.

During the surgery, the torn or attenuated MPFL is reconstructed using a graft, typically a hamstring tendon autograft or an allograft tendon. The graft is secured into bone tunnels or sockets created in the medial aspect of the patella and the medial femoral condyle, restoring the restraint against lateral patellar translation.

MPFL reconstruction aims to restore patellar stability and prevent recurrent dislocations or subluxations. It may be performed in isolation or in combination with other procedures, such as tibial tubercle osteotomy or trochleoplasty, depending on the underlying anatomical abnormalities.

Proper patient selection, surgical technique, and postoperative rehabilitation are crucial for successful outcomes. Complications may include graft failure, patellofemoral osteoarthritis, stiffness, and persistent instability or pain.

Overall, MPFL reconstruction is an effective surgical option for treating recurrent patellar instability, particularly in patients with predisposing risk factors and anatomical abnormalities contributing to the instability.

Tibial Tuberlce Osteotomy

Tibial tubercle osteotomy (TTO) is a surgical procedure performed to correct abnormal tracking of the patella (kneecap) within the trochlear groove of the femur. It is often indicated in patients with recurrent patellar instability or dislocation due to an increased tibial tubercle-trochlear groove (TT-TG) distance.

The TT-TG distance represents the lateral displacement of the tibial tubercle, which is the attachment point of the patellar tendon on the tibia. An increased TT-TG distance can cause excessive lateral pull on the patella, predisposing it to instability or dislocation.

During a TTO, Tom Kurien carefully cuts and repositions a segment of bone containing the tibial tubercle, moving it medially to reduce the TT-TG distance and improve patellar tracking. The bone segment is then secured in its new position with screws or a plate, allowing it to heal and provide a more optimal alignment for the patella.

TTO is often performed in conjunction with other procedures, such as medial patellofemoral ligament (MPFL) reconstruction, to address multiple factors contributing to patellar instability. It may also be combined with procedures to address trochlear dysplasia, such as trochleoplasty.

Proper patient selection, surgical technique, and postoperative rehabilitation are crucial for successful outcomes after TTO. Potential complications include non-union, overcorrection or undercorrection, and persistent instability or pain.

Overall, TTO aims to restore normal patellar tracking and stability in patients with increased TT-TG distance and recurrent patellar instability or dislocation.

Trochleoplasty

Trochleoplasty is a surgical procedure performed to address trochlear dysplasia, which is an abnormal shape or flatness of the trochlear groove in the distal femur. This anatomical abnormality can predispose patients to recurrent patellar instability or dislocation.

During a trochleoplasty, the surgeon focuses on reshaping and deepening the trochlear groove to create a more anatomically congruent surface for the patella to track within.

Trochleoplasty aims to improve patellar stability and reduce the risk of recurrent dislocation or subluxation (partial dislocation) by providing a more anatomically congruent trochlear groove for the patella to engage within.

This procedure is often performed in conjunction with other procedures, such as medial patellofemoral ligament (MPFL) reconstruction or tibial tubercle osteotomy, to address multiple factors contributing to patellar instability.

Proper patient selection, surgical technique, and postoperative rehabilitation are crucial for successful outcomes after trochleoplasty. A discussion with Tom Kurien will determine whether trochleoplasty is a suitable operation for your case.