Patella (Kneecap) Instability

Restoring Confidence in an Unstable Kneecap

The patella (kneecap) normally glides smoothly within a groove at the front of the knee. In some patients, it can partially or fully slip out of this groove - a dislocation - causing sudden pain, swelling, and a feeling that the knee is going to give way. Some people experience this only once, while others go on to have recurrent episodes of instability.

Dr Adam Farrier is a consultant knee surgeon offering patella (kneecap) stabilisation surgery for patients in Carlisle and across Cumbria, including West Cumberland (Whitehaven), and in Newcastle upon Tyne and the North East.

Is Surgery Right for You?

A first-time patella dislocation is often managed without surgery, through bracing and a structured rehabilitation programme focused on strengthening the muscles that support the kneecap. Surgery is generally considered for recurrent dislocations, or where specific anatomical risk factors - such as a shallow trochlear groove or patella alta - make further dislocation likely.

The Procedure

The most common surgical approach is reconstruction of the medial patellofemoral ligament (MPFL), the key soft-tissue restraint that normally prevents the kneecap from slipping sideways. In more complex cases, this may be combined with a bony procedure to correct an underlying alignment problem contributing to the instability.

The Benefits of Surgery

• Restoring Kneecap Stability: MPFL reconstruction directly addresses the structure most commonly responsible for recurrent patella instability.

• Reducing the Risk of Further Dislocation: Surgery significantly reduces the likelihood of future dislocation events compared to non-surgical management in patients with recurrent instability.

• Protecting the Joint Surface: Repeated dislocations can damage the cartilage behind the kneecap over time; addressing instability helps protect this surface.

• Returning to Activity with Confidence: Many patients regain the confidence to return to pivoting sports without the fear of their knee giving way.

Important Considerations & Risks

• Not Every Case is the Same: Some patients have additional bony risk factors that may need to be addressed alongside the ligament reconstruction for the best result.

• Stiffness: As with other knee ligament surgery, some early stiffness is common and is managed with structured physiotherapy.

• Recurrent Instability: While uncommon after appropriate surgery, a small risk of further instability remains, particularly where significant underlying anatomical risk factors are present.

Frequently Asked Questions

Do I need an MRI or CT scan before surgery?

Yes, detailed imaging helps identify the specific anatomical factors contributing to your instability, which is essential for planning the right surgical approach.

Will I need a brace after surgery?

Most patients use a brace for a period after MPFL reconstruction to protect the healing graft while early rehabilitation begins.

Can both patella instability and cartilage damage be treated at the same time?

Yes, where cartilage damage has occurred alongside instability, this can often be addressed in the same operation.

Dr Farrier's Note

"Patella instability has a number of different underlying causes, and identifying the right one for each patient is the key to successful treatment. A tailored approach gives the best chance of a stable, confident knee going forward."