#treatment - Knee

Patellofemoral Surgery

  • Patellofemoral symptoms of pain, swelling and giving way are extremely common.
  • They can result from a number of problems affecting the muscles, ligaments, joint lining and cartilage surface.
  • Patellofemoral pain and swelling requires expert investigation and diagnosis to avoid inappropriate treatment.
  • Instability of the patellofemoral joint with recurrent dislocation can be a disabling condition in active people.
  • By appropriate investigation and the right management most conditions of the patellofemoral joint can be successfully treated.

What is the patellofemoral joint?

The patella (kneecap) is a bone within the tendon of the quadriceps muscle in the front of the knee joint and it acts like a pulley around the knee joint to direct the action of the quadriceps muscle to straighten (extend) the knee. The patella is attached to the quadriceps muscle by the quadriceps tendon and via the patellar ligament to the front of the tibial bone.

What symptoms arise from this joint?

Common symptoms are pain, swelling, giving way, clicking and catching. In bad cases the patella may dislocate with extreme pain and sudden collapse. Positional stiffness , or pain when getting up from prolonged sitting in one position, as in driving a car or sitting in front of a computer is  often a presenting symptom. Patellofemoral  symptoms are aggravated by squatting, kneeling, going up or down stairs (often worse going down). The symptoms are often absent whilst walking on the flat on even ground.

What can be done about the symptoms?

First of all a definitive diagnosis must be made. There are a great number of causes of patellofemoral symptoms. At our SPORTS ORTHOPAEDIC CLINICS we pride ourselves in making the correct diagnosis before offering any treatment.

The diagnostic process includes an appropriate history and examination. Blood tests may be necessary. Xrays, MRI scanning of the knee joint with specific measurements of the position of the patella in relation to the femoral trochlea, sometimes CT scanning and occasionally radioactive bone scans are taken and carefully analysed by our surgeons themselves and shown to you so that we can pinpoint the problems and discuss their implications. The diagnostic procedure can often be completed in one day but may require a follow-up appointment in some cases.

What treatment options are available?

The treatment plan suggested will depend upon the diagnosis. The treatment options for patellofemoral pain include pharmacological, physiotherapeutic, splintage, soft tissue operations and bony operations. We will consider all of these options with you and discuss them in detail with you.

What are the surgical options?

Arthroscopic surgical procedures

Soft tissue surgical procedures for patellofemoral symptoms can be arthroscopic or open procedures. The arthroscopic procedures are mostly done as day surgery cases or one night stay (see KNEE ARTHROSCOPY ). In many cases chronic patellofemoral pain involves mainly the synovial structures of the knee such as the plicae, or synovial folds which can be successfully treated arthroscopically. All arthroscopic procedures will involve taking appropriate still (jpg) and movie (mpg) pictures.

Open surgical procedures

These are mostly aimed at correcting the unstable patella with maltracking or recurrent dislocation involving chronic or repeated episodes of pain. They may involve soft tissue and/or bony procedures such as tibial tubercle transfer.

Open procedures will involve a longer time in hospital – between 2 and 5 days- and may involve postoperative bracing of the knee or a period using crutches partial weight-bearing for a short period for stabilization and confidence. They will NOT INVOLVE PLASTER OF PARIS IMMOBILISATION OR THE USE OF TOURNIQUETS both of which we believe slow down the recovery time.

Recovery

Physiotherapy will be an important part of the postoperative treatment after the wounds have healed FROM ABOUT 2 WEEKS TO THREE MONTHS. and the total time back to sporting activities such as football and rugby should be about 12 months (you will miss a season).

Getting back to work following an open procedure for patellar instability depends upon the nature of your work and the distance and transport method you may have to use to commute to your place of work.