Prof (Dr) Ujjwal K Debnath, Consultant Orthopaedics & Spine Surgeon
Operative treatment of acute patellar dislocations may result in a lower rate of recurrent dislocations than non-operative treatment (24.0% vs. 34.6%). A lateral release is the simplest and most commonly performed surgery to address patellar instability. A medial imbrication is a procedure to tighten the tissue on the inner side of the knee. The most modern procedure being performed for patellar dislocation addresses an important ligament called the medial patellofemoral ligament, or MPFL. Some patients may have a shallow groove on the end of the thigh bone or abnormal alignment of the lower extremity. In these situations, the usual surgery is aligning the extremity by positioning the tibial tubercle on the shin bone. By positioning of the tibial tubercle, the patella is pulled more to the inner side of the knee.
The patellar tendon and quadriceps tendon on the front of the knee joint can be injured, causing a loss of strength of leg extension. When the tendon is torn, patients have a difficult time straightening the knee joint. Treatment of a patellar tendon or quadriceps tendon rupture is nearly always a surgical repair. Without surgical repair, not only can straightening the knee be difficult, but even normal walking is sometimes challenging.
When the cartilage loss is limited to a small portion of the knee joint, it may be possible to replace just the worn-out portion of the joint. The knee joint is generally divided into three compartments, and each of these three compartments (medial, lateral, and patellofemoral) can be replaced with a partial knee replacement. Partial knee replacement is considered if you are over 60, weigh less than 180 pounds (82 kilograms), and are unable to fully flex or extend the leg due to joint degeneration and/or deformity.
Knee osteotomy is the cutting of bone to correct the knee’s alignment and improve its function with the goal of reducing chronic arthritis knee pain. The two most common types of knee osteotomies are high tibial osteotomy, a reshaping of the shin bone, and femoral osteotomy, a reshaping of the thigh bone. An osteotomy usually just delays the need for a total knee replacement by at least 10 years.
When a surgeon adds or removes a wedge of bone to an area of the tibia (shin bone) just below the knee, it is called a high tibial ostoetomy. This surgery is most often done to relieve pain, improve function, and correct bow-legged alignment.
When a surgeon adds or removes a wedge of bone to the femur (thigh bone), it is called a femoral osteotomy. Typically, the bone is cut just above the knee. Less common than tibial osteotomies, femoral osteotomies are usually done to correct a knock-kneed alignment, improve joint function, and relieve arthritis pain.
