Patella Instability Treatment Options

Nonoperative treatment is usually the first step for patella instability, particularly in the absence of an osteochondral fracture or if it’s the first episode of dislocation. This approach is also well-suited for patients with low physical activity demands or those who are not surgical candidates due to other health conditions.

This approach encompasses rest, icing the knee, compression, and elevation (RICE protocol), along with pain management using nonsteroidal anti-inflammatory drugs (NSAIDs). Physical therapy plays an essential role in strengthening the muscles around the knee (especially the quadriceps), improving joint stability, and promoting a return to normal function. However, if nonoperative treatments do not provide relief or if dislocations continue to occur, surgical options may be considered.

Lifestyle Modification for Patella Instability

Lifestyle modifications may include changes to daily activities or sporting techniques that can prevent movements likely to cause patella instability or dislocation. This treatment option is particularly useful for older patients, or for those whose jobs or hobbies can be adjusted to reduce strain on the knee. Modifications might involve switching to low-impact exercises, adjusting squatting techniques, or modifying other movements that could put the knee at risk.

However, for young, active individuals or those with recurrent dislocations, lifestyle modifications alone may not be sufficient.

Physical Therapy for Patella Instability

Physical therapy forms the cornerstone of nonoperative management for patella instability. It’s geared toward strengthening the quadriceps muscle (especially the vastus medialis oblique), improving balance, and enhancing neuromuscular control. Despite its benefits, in some severe or recurrent cases of patella instability, physical therapy might not be able to fully address the issue.

Bracing for Patella Instability

Patellar braces or taping can provide mechanical support, improve patella tracking, and potentially prevent dislocation. This option is often combined with physical therapy. Bracing can be an excellent option for those who have had a single episode of dislocation or for those who have mild instability.

Surgery may be considered for patella instability when nonoperative treatments fail to alleviate symptoms or in cases of recurrent dislocation. Different surgical techniques can be employed, depending on the patient’s specific anatomical issues, age, activity level, and the presence of any concurrent injuries.

The timing of surgery depends on multiple factors including the patient’s age, activity level, and the specifics of their injury, but is typically not urgent unless there is a large piece of cartilage damage that could be repaired.

Lateral Release for Patella Instability

This arthroscopic procedure involves releasing tight structures on the outside (lateral side) of the knee to allow the patella to sit properly in the femoral groove. Lateral release is usually performed along with other surgical procedures. Recovery typically involves physical therapy to restore strength and range of motion in the knee. However, it has a risk of actually making the patella more unstable and worsening the problem.

Medial Patellofemoral Ligament (MPFL) Reconstruction for Patella Instability

In this procedure, a new ligament is created, often using a tendon graft, to prevent the patella from slipping out of place. This is generally considered for individuals with recurrent dislocations and who have a normal alignment of their lower extremities. Postoperative rehabilitation includes initial immobilization followed by a carefully supervised physical therapy program.

Tibial Tubercle Osteotomy (TTO) for Patella Instability

This procedure is performed when there is an abnormal alignment or tilt of the patella. The tibial tubercle—the bony prominence on the tibia (shinbone) where the patellar tendon attaches—is moved to improve the alignment and the patella’s tracking. Recovery involves a period of immobilization followed by rehabilitation to regain motion and strength in the knee.

Trochleoplasty for Patella Instability

In this procedure, the trochlear groove at the end of the femur is deepened so that the patella can better seat in the groove. This surgery is considered for those with a shallow or malformed trochlear groove. Postoperative care involves immobilization, limited weight-bearing, and gradually increasing physical therapy.