Patellofemoral (Kneecap) Instability and Pain - Patient Education and Solutions

Dr. Sabrina Strickland of the Hospital for Special Surgery in New York City discussed Patellofemoral (Kneecap) Instability and Pain.
sabrinastrickland.com
Patella (Kneecap) Instability
In the front of the knee the kneecap slides up and down in a groove in the thigh bone. Sometimes it can slip out causing pain, swelling and cartilage injury.
How does it feel?
It can feel unstable and in severe cases it can be difficult to fully extend the knee. Sometimes patients have to go to the ER to get the patella back into the groove. Often these injuries are accompanied by swelling and it can take weeks to months to feel normal again.
How does it happen?
In some patients it happens without any trauma and at a young age. In others it can occur playing sports with or without a contact injury. It can recur especially when it first happens before the age of 25.
How can it be fixed?
In most cases it can be fixed by reconstructing the MPFL (Medial PatelloFemoral Ligament) which is a minimally invasive surgery with a 4-6 month recovery. In patients who have suffered cartilage damage the surgery may be more complicated with the addition of a bone re-aligning surgery such as a tibial tubercle osteotomy and/or a cartilage replacement surgery.
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Patellar Pain And Arthritis
In the front of the knee the kneecap slides up and down in a groove (trochlea) in the thigh bone. Sometimes it can be malaligned or arthritic causing pain, swelling, and cartilage injury.
How does it feel?
It can feel unstable and hurt especially going down stairs, sitting for a long time, wearing high heels or doing squats or lunges. Often these conditions have caused pain for years and a change in weight or activity level can make it feel much worse.
How does it happen?
In some patients it happens without any trauma and at a young age. In others it can occur when they either get out of shape or ramp up activity quickly in an effort to get back in shape.
How can it be fixed?
In most cases it can be fixed by avoiding exacerbating activities, going to physical therapy, using injection treatments such as cortisone, hyaluronic acid and PRP. In some cases surgery is required to realign the patella within the groove (tibial tubercle osteotomy) or to replace the cartilage on either the kneecap or the front of the thigh bone (trochlea).

[@lorinajera2863]

Thankful for Doctors like you.

[@paulettegangemi2935]

Doc saved my knee with an MPFL. When other surgeons told me I’d never ski again, never exercise again. 8 years post-op I’m a ski patroller and skiing at a higher level than I did on the race team in college. Thank you Doctor Strickland!

[@kill3r672]

Hi Doc. thank you for the videos - I have been told (following MRIs) I have severe patella alta (insall salvati ratio 1.8) with some lateral tilt, Q angle is increased bilaterally, lateral subluxation of the patella three fourths laterally & medially, dysplastic trochlea, TT-TG distance of 26mm, severe chondral damage to the patella & to the dysplastic trochlea, Clarke's test is positive, tibial tuberosity placed laterally.... I have been advised to not take part in any physical activity that puts force through the knee & have been referred to be seen by a specialist surgeon, but the wait time is long as I am going through the NHS (UK) - I know it is hard to say without images, but I'm guessing this will result in surgery- so my question is, what sort of surgery would typically be performed to fix the above?

[@SabrinaStricklandMD]

In the United States we have different option for cartilage repair than the UK. It sounds like you would need a tibial tubercle osteotomy with a cartilage transplant for your patella and trochlea. You should be able to be active once this is fixed. Best of luck finding treatment.

[@kill3r672]

Thank you @@SabrinaStricklandMD for the response and the kind words. Keep doing the good work you do and stay safe.

[@gunnargerritsen9154]

On 2-12 I will have anteromediale tuberositas tibiae transposition. And on 6 oktober my left knee will be done. My shoulder orthopedic surgeon had her studie in Boston.

[@matthewlindsay1372]

I'm 39 and just had a knee scope to remove several large bodies from my knee (a half dozen of 1cm diameter). This is my third surgery, second scope (originally surgery at 16 yrs old). Doc after my recent surgery/scope said it was worse than he thought and I have Stage 3 and 4 wear of my cartilage on the underside of my knee cap and on the groove where my knee cap rests. I don't have instability, but they believe it is not resting correctly. They said a possible option is a "Tibial tubercle osteotomy" to get better knee cap alignment with the groove. I'm told I'm not a candidate for cartilage transplant given I have a 'kissing' wear problem. Anyway, my question is this "Tibial tubercle osteotomy" the logical next fix? If so, should I do it sooner than later so I don't wear away what cartilage I have left?

[@SabrinaStricklandMD]

Hi Matthew. This is a complicated question to answer without actually seeing your MRI. Bipolar or kissing lesions can be treated with an cartilage transplant on both the patella as well as the front of the femur. This is virtually always done with a tibial tubercle osteotomy unless your alignment is optimal. At 39, we certainly try to do everything possible to avoid a partial knee replacement. I don't know if you live anywhere near New York, but I'd be happy to see you. I also do telehealth for presurgical visits or you could see a patella specialist if there is one in your area.

[@SabrinaStricklandMD]

Here's contact information for my office if that works for you: sabrinastrickland.com/contact-dr-sabrina-strickland/