In most cases, patella instability can be managed non-operatively, with a good physiotherapy and rehab program that trains the muscles to help stabilise the patella or kneecap. Surgery is considered when this has not been successful in maintaining the stability of the patella, or there are other symptoms within the knee due to the instability.
Arthroscopy may be needed if a loose body has been identified within the knee on an MRI scan. This is usually a very small piece of cartilage that has been chipped off at the time of the dislocation. It may be possible to fix this piece back in place if it is big enough, but most of the time it is too small and needs to be removed.
Other surgical options include lateral release, medial patellofemoral ligament (MPFL) reconstruction, or open re-alignment surgery. There are different indications for each type of surgery, depending on your particular pattern of patellar instability.
Lateral release can be performed arthroscopically, and releases ligaments on the lateral side of the patella that have become too tight and pull the kneecap out of position.
An MPFL reconstruction uses a graft tendon, usually a hamstring tendon, to replace the native ligament, which is usually damaged after a dislocation. This normally acts as a constraint, to stop the patella from dislocating laterally.
Open re-alignment surgery involves cutting the bone at the attachment of the patella tendon and re-aligning or transferring it, to counteract rotational or angular forces that allow the patella to slide out of its groove.
After any surgery, physiotherapy will be necessary to help you to regain range of motion and muscle strength. This is essential for maintaining patella stability and allowing you to return to your normal activities as quickly as possible.