Surgery Options for Patellar Tracking Disorder

Topic Overview

Several types of surgery can be used to treat patellar tracking disorder or a dislocated kneecap, depending on what is causing the problem. These are some that are commonly done.

Lateral release surgery

One cause of patellar tracking disorder is a tight lateral retinaculum. This is a ligament that anchors the outer edge of the kneecap (patella).

If tightness in this ligament is pulling your kneecap to the side, a surgeon may recommend lateral release surgery to cut the ligament. It is often done with arthroscopic surgery, which involves inserting a thin tube that contains a camera and light through a small incision near the joint.

Medial patellofemoral ligament repair

The medial patellofemoral ligament (MPFL) attaches to the inner edge of the kneecap to help keep it from slipping toward the outside of the knee.

A damaged MPFL can be repaired with arthroscopic surgery. Repair surgery may be the right choice if the ligament was:

• Torn by injury to the knee.
• Stretched and damaged by kneecap dislocation.

In most people, repairing the MPFL makes the knee joint more stable. But some people will have another dislocation after the surgery. And many people still have pain and swelling. This may be due to cartilage damage on the underside of the kneecap.

Some surgeons think it is best to repair MPFL damage right away the first time the kneecap dislocates. Other surgeons will wait until it becomes a repeated problem.

Osteotomy

An osteotomy is a surgery that involves cutting the bone. It may be a good treatment option if patellar tracking disorder is caused by a problem with the alignment or structure of the knee.

A tibial tubercle osteotomy moves the tibial tubercle, which is the bump of bone where the patellar tendon goes into the shinbone (tibia). This is most often done for one or a combination of conditions in which:

• The kneecap slips sideways out of its normal location.
• A very long patellar tendon lets the kneecap slide too high on the knee joint. This is called patella alta.

A tibial tubercle osteotomy is often combined with a lateral release.