Patellar Stabilization

MPFL Reconstruction   /   Tibial Tubercle Transfer

Arthroscopy is a minimally invasive surgery technique. Two small incisions are made around the joint to allow a camera and various instruments to pass through. Small instruments are used to visualize the anatomic structures and assess tracking of the patella. The cartilage surfaces are also carefully examined. Occasionally, loose fragments in the joint are removed. The knee cap is then stabilized by attaching a tendon to the inside of the knee cap and adjacent thigh bone. In cases of abnormal alignment of the knee cap relative to its attachment site to the prominent part of the upper shin bone (called the tibial tubercle), this portion of the bone is cut and shifted over to improve the alignment and tracking of the knee cap.

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Procedure

A knee arthroscopy is a minimally invasive procedure that includes creating 2 small incisions (roughly 0.5 inch each) around the knee joint. These small portals allow a camera to enter the joint for visualization of anatomic structures, as well as tools to repair any injured structures. The anatomic positions of the MPFL are identified on both the inside of the patella and femur. A graft that is harvested from the patient or from a cadaver is used to reconstruct the ligament, and it is anchored to the bone with screws and anchors.

In cases of an elevated tibial tubercle-trochlear groove (TT-TG) distance, the tibial tubercle (bony prominence in the front of the upper shin bone) is cut and moved to a better position to improve the alignment and tracking of the knee cap. The tibial tubercle is then secured in place with screws to stabilize the bone until it heals, which usually takes 6-8 weeks. Occasionally, part of the trochelar groove needs to be reshaped to deepen the groove with a procedure called a trochleoplasty.

  • This surgery is most often performed under general anesthesia with a nerve block, but can be performed with a nerve block and sedation.
  • This surgery is usually outpatient, which means the patient will be able to go home the same day.
  • Surgery typically lasts 1.5-2 hours.
  • Patient will be fit for a brace at a preop appointment before surgery and will need to bring this to surgery.
  • The brace will be placed on the patient prior to waking up from anesthesia.
  • The incisions will be closed with absorbable suture with dressings that can usually be removed 2-3 days after surgery.
  • The brace will need to be worn locked in full extension all of the time, including at night, but may be removed for hygiene purposes.

Frequently Asked

Questions

Can I bear weight after surgery?

Yes, as long as the brace is locked in full extension. Physical therapists will work with you to help you regain your range of motion and strength.

Can I drive after surgery?

You should not drive for 6 weeks if your operative leg was the right leg. If the operative leg was your left leg, we recommend not driving for a few days after surgery and as long as you are not taking any narcotics.

How can I manage my pain?

A prescription for a narcotic will be given to you at your preoperative appointment. Dr. Faulkner or his PA, Cara, will review instructions for this medication and what other over the counter medications can be taken to control pain. Risks and side effects will also be discussed.

When do I start physical therapy?

You will typically start physical therapy 2 weeks after surgery.

How long do I have to wear my TED hose?

TED hose are worn to prevent blood clots in the legs. These should be worn for several hours a day for 2 weeks after surgery.

Do I need to take any medication to prevent risk of blood clots?

You should take an Aspirin 325 mg to prevent the risk of blood clots for 2 weeks after surgery. If you have a personal history of blood clots or other risk factors, Dr. Faulkner or his PA, Cara, may prescribe a stronger blood thinner.

Can I shower?

You may shower 48 hours after surgery. The dressings placed over the incision may be removed at this time; however, the steri-strips should be left in place. You may get the incisions wet, but please but should not soak them in water until the wounds have completely healed.

I am told I need surgery. What next?

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