Patella (Kneecap) Realignment Surgery

The patella or kneecap as it is more commonly known, is a thick, flat triangular bone that sits in a groove at the end of the thighbone (femur) called the trochlea. The patella, thighbone (femur) and the shinbone (tibia) make up the knee joint. 

The patella is located inside of a tendon and is the second largest sesamoid bone (a bone embedded within a tendon) in the human body. This tendon connects the thigh muscle (quadriceps) to the shinbone just below the knee joint and so is absolutely critical to knee movement and mobility.

The patella moves up and down in this groove when the knee bends or straightens. If the patella sits centrally on the thighbone and does not deviate then the patella is functioning normally. This movement is called ‘patella tracking’, however, if the patella slides out of its normal position and into patella subluxation, then the irregular movement will cause pain in the patella and in some cases can lead to dislocation. Abnormal movement of the patella can be the result of a blow to the knee during sport or a bad fall or knock to the knee, through poor alignment due to shallow grooves where the kneecap sits, being very flexible or double jointed.

   Normal Trochlea

  Normal Trochlea

Some patients have an abnormality of the groove that the patella normally glides in. In some cases, the anatomy of this groove may have to be corrected surgically. This procedure is called a trochleaplasty. Mr Geutjens is one of the very few surgeons in the country who offers this procedure and has ten years experience with this procedure.

Dysplastic Trochlea

Dysplastic Trochlea

Corrective patella surgery is not always necessary to correct irregular movement as sometimes using physiotherapy strengthening exercises aimed at the hip abductor and hip flexors to develop better control of the kneecap can help. Also, if a patient is overweight, by combining a weight loss programme with exercise can also help with improving in the range of movement and remove the need for surgery. However, if the injury is severe, then patella realignment surgery will be recommended.

After Surgical Trochleaplasty

After Surgical Trochleaplasty

How is Patella (Kneecap) Realignment Surgery Performed?

If your Knee Surgeon feels that the best course of action is a surgical procedure then he will probably recommend arthroscopic patella surgery. It may be that an arthroscopy procedure has already been used as part of the exploratory and diagnosis process. This is a less invasive method of patella realignment surgery and one used widely by surgeons. A general anaesthetic or spinal block will be given. An incision is made just above the knob of the knee (tibial tubercle) by the surgeon who will then separate the tibial tubercle and the patella tendon from the shinbone (tibia). This route allows the surgeon to then correct the poor alignment of the kneecap in relation to the thighbone (femur).

Recovery from Patella (Kneecap) Realignment Surgery

After having patella surgery, you will be discharged the same day, or if the surgeon feels more medical observation is required, you will be asked to stay overnight.

As with any surgery where a general anaesthetic has been administered, you will feel tired as well as feeling some discomfort and pain resulting from the surgery itself. Pain relief will be given in the first few days and ice will be applied to the knee to help reduce swelling. An important part of the recovery and rehabilitation process will be physiotherapy and so before leaving hospital, you will be seen by a physiotherapist who will take you through the exercises required to help speed your recovery.

Returning to gentle sports such as swimming can usually happen within 4 weeks, however, more vigorous exercise usually takes around three to six months.

Surgery Consultation Process

As with all surgical procedures, Mr Guido Geutjens, Specialist Knee Surgeon, takes all of his patients through a thorough examination and diagnosis process before any surgical procedure is performed. Mr Geutjens will always ensure that a surgical approach is the most appropriate option and will fully explain the benefits and risks involved with any surgical procedure before proceeding.