How do you fix patellar instability?

Patellar instability refers to the kneecap (patella) moving out of its normal alignment, usually dislocating or subluxing (partially slipping out) from the trochlear groove at the end of the thigh bone. This condition can cause pain, limited movement and repeated injuries if not properly addressed. The approach to fixing patellar instability depends on the severity of the issue, the frequency of dislocations, and the individual’s anatomy and activity level.

What causes patellar instability?

Patellar instability often arises from one or more of the following:

• A previous traumatic dislocation
• Ligament laxity or hypermobility
• Shallow or misshapen trochlear groove
• Misalignment of the lower limb
• Weakness in the quadriceps or imbalance in thigh muscles

What are the symptoms?

Symptoms typically include:

• A feeling that the knee might give way
• Pain or swelling following activity or dislocation
• A visibly displaced kneecap (in dislocation)
• Limited range of motion or stiffness

How is patient quality of life is affected by patella instability?

Patella instability can severely impact a patient's life, especially in sports and personal confidence. Many avoid physical activities due to fear of dislocation, limiting participation in sports they once enjoyed. This often leads to frustration, social withdrawal, and a decline in self-esteem, as daily movement feels uncertain and unreliable.

How is it diagnosed?

Diagnosis starts with a clinical examination and a review of symptoms. Imaging tests like X-rays, MRI scans or CT scans are often used to evaluate bone structure, ligament integrity, and the alignment of the patella.

What are the non-surgical treatments?

Initial treatment for first-time or mild instability often begins conservatively:

• Physiotherapy to strengthen the quadriceps and improve tracking of the kneecap
• Bracing or taping to help stabilise the patella during movement
• Activity modification to avoid stress on the knee
• Pain relief through anti-inflammatory medication if required

Many patients respond well to these approaches, especially when dislocation has only occurred once.

When is surgery needed?

Surgery may be recommended if:

• Dislocations are recurrent
• There is damage to cartilage or supporting ligaments
• Conservative treatments have failed

What surgical options are available?

There are several procedures, and your orthopaedic surgeon will choose the most suitable one based on your anatomy and needs:

• MPFL reconstruction (medial patellofemoral ligament): The MPFL helps keep the patella in place. Reconstructing it with a graft can restore stability after recurrent dislocations.
• Tibial tubercle osteotomy: If the patella is misaligned due to abnormal bony attachment, the point where the patellar tendon attaches can be repositioned to improve tracking.
• Trochleoplasty: This is done when the groove in the femur is too shallow or misshaped. The surgery deepens the groove to help guide the patella correctly.

What’s the recovery like?

Recovery depends on the type of surgery but usually involves:

• Several weeks of limited weight-bearing
• Physiotherapy for three to six months to regain strength and movement
• A return to sports or high-impact activities usually after six to nine months, depending on progress

Can patellar instability be fully resolved?

In many cases, yes. With the right diagnosis and treatment - whether conservative or surgical - patients often regain full function and return to their normal activities. Early management of patellar instability is key to preventing long-term damage to the knee joint.