Complaints unstable patella (kneecap)

The patella is located at the front of the knee and is important for being able to stretch and bend the knee. The patella connects the muscles in the front of the thigh to the tibia. As you bend or straighten your leg, the patella is pulled up or down. The femur has a V-shaped notch (femoral groove) at one end to accommodate the moving patella. In a normal knee, the patella fits nicely in the groove. But if the groove is uneven or too shallow, the patella could slide off, resulting in a partial or complete dislocation. A sharp blow to the patella, as in a fall, could also pop the patella out of place. As long as your patella stays in its groove, you can move easily. When the patella slips out of the groove, problems and pain often result.

During the physical examination, you may asked to walk around or to straighten and bend your knee. The doctor may carefully feel the area around your patella and take measurements to determine if the bones are out of alignment or if the thigh muscles are weak. X-rays are recommended to see how the patella fits in its groove. Your doctor will also want to eliminate other possible reasons for the pain, such as a tear in the cartilage or ligaments of the knee.

Treatment patella stabilization

If the patella has been dislocated out of its groove, the first step is to return the patella to its proper place. Sometimes, this process happens spontaneously or with gentle force to push the patella back in place.

A dislocation often damages the underside of the patella and the end of the tibia, which can lead to additional pain and arthritis. Arthroscopic surgery can correct this condition.

If the patella is partially dislocated, your surgeon may recommend nonsurgical treatments, such as exercises and braces. Exercises will help strengthen the muscles in your thigh so that the patella stays aligned.

Bicycling is often recommended as part of the physical therapy. A stabilizing brace may also be prescribed. The goal is for you to return to your normal activities within 1 to 3 months.

A chronic condition, in which the knee continues to be unstable, can often be corrected by surgery. For example, surgery can be used to realign and tighten tendons to keep the patella on track, or to release tissues that pull the patella off track.

Preperation

How to prepare for your operation

• Prior to your surgery, you will have a physical examination and you will be given a written prescription for pain medication. First you visit the doctor's assistant to discuss with you what will happen before, during and after the treatment and the various forms of anesthesia and pain management, both during and after surgery. More information about anesthesia, you can read here.
•  The doctor's assistant may check your health and finally the day of surgery is scheduled.
• You should borrow crutches as you will need them to walk for a few days following your surgery.  For more information: www.thuiszorgwinkel.nl
• Usually it takes a few weeks to walk with a crutch at home. If you have lack of help at home please discuss this with the transfer nurse of the Vlietland hospital or home care setting of your home.

The day of surgery

• You should bring your crutches and personal items such as medicines. You wear comfortable clothing and shoes and leave valuables at home as much as possible.
• You appear sober at the clinic
• After pre-operative preparation you will positioned and treated in the operating room
• Generally after the operation a brace or plaster is moored
• After surgery you will be moved to the recovery room
• The physical therapist will explain how you can exercise at home and how to use the crutches safely.
• When you are restored sufficiently, the anesthesiologist will agree with your dismissal.
• You may not drive home by yourself

Recovery

The recovery period of the patella stabilization comprises 6 to 12 weeks.  Consider a period of approximately 6 months in which you perform exercises to achieve full recovery.

The recovery period is as follows:

• The knee will be swollen and tender. Especially the first day after surgery creates the pain and swelling for the inconvenience.
• If the plaster or brace is removed, the muscles of the leg are diminished. With practice, you must rebuild the muscles strength

Your recovery is supervised by a physical therapist. He or she will coordinate the resumption of sports.  During the recovery process, you will return to a more active and normal lifestyle within a few months.

Complications

Surgery is not without risks and complications can arise. Although the risk of a complication of this type of surgery is very low. complications may be related to anesthesia or infections.

Consult your surgeon with the following complications:

• Bleeding from the wounds or bleeding in the knee.
• The wounds remain sensitive
• There may be a thrombosis or pulmonary embolism occur.
• Infection of the knee joint
• Damage to the knee arthroscopy structures around the knee, such as nerves or blood vessels; which is very rare

Expectations

Treating a patella stabilization is a relatively simple technique with an intensive revalidation process. The recovery period after surgery, the knee is in most cases free of pain and stable. However, a knee with major damage of the cartilage may not be entirely free of pain.

Frequent asked questions

How do you decide which procedure is right for me?
This determines your orthopedist and depends on the reason why the patella does not fit anymore. If the chute of the patella itself is not properly constructed then another surgery may be indicated than if an accident lead to a dislocated patella.  

Do I need help at home after surgery?
The first few days you are not as mobile as usual so it's nice when family or friends will give you a helping hand. For the first 24 hours after surgery you should not be left alone. This is if you need help or unforeseen problems arise.

Is there an OK alternative, because of my medical history, for Delft Orthopedium?
Yes, then your orthopedic surgeon will operate you in the Vlietland hospital at Schiedam.  

When can I return to work, play sports and participate in traffic?
Depending upon where your work is located and if you need to climb stairs, you should be able to return to some work starting about one week after surgery. The time off is about 1-3 weeks. If your job is sedentary, the time off is about the same, 1-3 weeks. If you are involved in heavy manual labour, then the return to work depends on the progress of your recovery.  Discuss this with your surgeon.

It is not advisable to participate in traffic if you sue painkillers and /or crutches. Discuss this with your surgeon and read the policy conditions of your insurance.

When should I contact Orthopedium clinic?
For questions please contact us during business hours; you can reach us by phone 088-0088444.

Do I need physical therapy after surgery?
Yes, you should discuss starting any exercise program with your orthopedic surgeon or physical therapist prior to initiating it.

Can I use my knee after knee arthroscopy instant full load?
Usually, the knee can fully be loaded one week after surgery.

Why do I stay sober for the surgery?
You should be sober before a surgery otherwise you might vomit during the operation, which can cause suffocation or pneumonia.  

How long takes the procedure?
The average duration is approx. one and a half hours. If your orthopedic surgeon suggests for a hospital admission, it may be possible to leave the hospital after a night.

Prepare yourself by reading all the information given. For any questions please telephone or email contact with Orthopedium.