Patellar Malalignment
What is patellar malalignment?
Patellar malalignment is a condition where the the kneecap does not track properly within the femoral groove when the knee flexes. Instead, tracking may be shifted outward (lateral tracking) or, less commonly, inward (medial tracking), which causes pain and discomfort, particularly when bending.
Malalignment can occur following a fall or sprain resulting in insufficiency of the medial patellofemoral ligament (MPFL), or due to the presence of bone deformity, tendon defects or excessive rotation.
Indications and contraindications for treatment of patellar malalignment.
Treatment is neccessary when abnormal tracking results in:
Recurrent sensations of knee giving way.
Contraindications for treatment include:
Advanced arthritis: where damage will limit the efficacy of realignment.
Active infection (local or general).
Poor general health, including uncontrolled diabetes, severe heart disease or advanced lung disease.
Benefits and complications of patellar malalignment treatment
Benefits
- Relief from painful symptoms.
- Restoration of function and improved mobility.
- Joint preservation.
- Alignment Correction.
Known complications
- Permanent nerve damage resulting in sensory or motor deficits.
- Superficial or deep infection.
- Vascular injury and bleeding.
- Pain.
- Deep Vein Thrombosis (DVT).
- Over- or undercorrection.
- Nonunion or delayed healing.
The surgery
Patellar malalignment has, historically, been treated using closed reduction and immobilisation, supported by a program of physiotherapy focusing on quadriceps and vastus medialis obliquus strength, muscular stretching and joint flexion. Where comservative treatment fails, there are more than 100 surgical procedures indicated for patellar malalignment.
Preparation prior to surgery
- You will receive a thorough health assessment: including medical history. You may be advised to modify certain lifestyle factors and you may be referred to another specialist. You may be asked to stop taking certain medications as your surgery date approaches. X-rays, CT scans, and MRIs will be used to evaluate your condition and plan your surgery.
- Skin and bowel preparation: On the evening before your surgery, you will be asked to wash your leg using the sponge provided at your pre-admission clinic. A skin test may be administered if an iodine allergy is suspected. You will also be provided medicine to help you evacuate your bowels prior to surgery.
- Patient education: if neccessary, you may speak with a physiotherapist who can advise you on post-operative mobility.
On the day of the surgery
- You will be asked to complete your surgical paperwork and will meet with the anaesthetist.
- The surgical site will be prepared.
- You will be administered general or regional anaesthesia.
- A small incision will be made at the knee to allow arthroscopic assessment.
- Loose fragments of bone or ligament will be removed
- Tight soft tissue may be released and the MPFL reconstructed
- If indicated, bony deformities may be addressed.
- X-rays are taken to confirm positioning.
- The wound is sutured and dressed.
After your surgery
- In-patient care: you will remain in hospital for several days for monitoring and early-stage rehabilition.
- Pain and swelling: You may experience mild to moderate pain. You will be prescribed painkillers to manage these symptoms.
- Mobilising: You may require a walker or crutches for six to twelve weeks after your surgery, though you will be encouraged to mobilise soon after your surgery.
- Aftercare: at one week post-surgery, you will be required to attend a wound check and at two weeks your sutures will be removed. At 6 weeks, you will undergo further X-rays to assess healing, and at three months after your surgery for the same reason. You may be prescribed blood thinners to reduce the risk of a clot developing.
- Physiotherapy: a tailored program of exercises will be provided to improve motion, mobility and muscle strength around the knee.
Concerns
If you are concerned about your pain level, or develop significant bleeding, fever or redness around the surgical site, please contact us immediately. For after-hours support, contact the hospital at which your surgery was completed. They will contact Prof. Al Muderis on your behalf.
Norwest Private Hospital: (02) 8882 8882
Macquarie University Hospital: (02) 9812 3000
This treatment could be eligible for our
No 'Out-of-Pocket' Expenses Program
For further information, click here or to check your eligibility, please contact our team.
