Kneecap (Patella) Surgery

The Kneecap (Patellofemoral Joint) and Common Problems

The patellofemoral joint is the joint between the kneecap bone (patella) and the groove (trochlea) on the thighbone (femur) in which the kneecap sits. Smooth movement of the patella within this groove is critical for healthy knee function. The main problems affecting this joint are as follows:

• Patellar Instability: Complete displacement of the kneecap out of the groove it normally sits in (dislocation) or partial slipping (subluxation). This condition usually begins after trauma but can become recurrent.
• Patellofemoral Pain Syndrome (PFPS): Widespread anterior knee pain felt behind or around the kneecap, which typically increases when going up and down stairs, squatting, or after prolonged sitting.
• Patellofemoral Cartilage Damage: Limited (focal) damage to the cartilage surface beneath the kneecap or on the groove (trochlea) of the thighbone.
• Patellofemoral Osteoarthritis: Widespread wear and deterioration of the cartilage in the patellofemoral joint.

Goal of Kneecap Surgery: The main goals of surgical treatment are;

• To restore stability by preventing recurrent kneecap dislocations,
• To relieve chronic pain,
• To restore proper tracking of the kneecap,
• To correct any underlying anatomical problems (malalignment, ligament insufficiency),
• To improve knee function and enhance the patient’s quality of life.

Conditions Requiring Kneecap Surgery

Surgical treatment is generally considered in the following situations:

• Recurrent Patellar Instability: Two or more episodes of kneecap dislocation, or persistent subluxation and a feeling of instability. Surgery may be recommended especially in young, active patients when there is an underlying problem in the ligaments or bone structure.
• Traumatic First-Time Dislocation (Certain Cases): Even in a first-time kneecap dislocation, surgery may be considered if a piece of cartilage or bone has broken off along with the dislocation (osteochondral fracture) or if there is a significant ligament tear (especially of the MPFL).
• Severe Patellofemoral Pain (Rare Cases): Severe anterior knee pain due to an underlying structural problem (e.g., significant cartilage damage, marked malalignment) that persists despite prolonged (at least 6 months) and intensive conservative treatment (physical therapy, medication, activity modification). Surgery is rarely performed for pain alone.
• Symptomatic Patellofemoral Cartilage Damage: Significant focal cartilage damage causing symptoms such as pain, catching, or locking, and that does not respond to conservative treatment.
• Severe Patellofemoral Osteoarthritis: Severe osteoarthritis affecting only the patellofemoral joint or the entire knee, in which other treatment methods have failed.

What Symptoms Suggest the Need for Surgery?

The following symptoms, especially if they do not respond to conservative treatment, may suggest the need for kneecap surgery:

• Recurrent Kneecap Dislocation or Subluxation: A feeling that the kneecap is moving out of place, or a visible dislocation.
• Giving Way or a Feeling of Instability in the Knee: A feeling that the knee moves out of control, especially during sudden movements or twisting.
• Anterior Knee Pain: Pain felt behind or around the kneecap that increases with activities such as going up and down stairs, squatting, running, or prolonged sitting (“moviegoer’s knee”).
• Catching, Locking: Sudden pausing or locking during knee movements.
• Swelling: Recurrent knee swelling, especially after activity.
• Noise (Crepitus): A grinding or creaking sound during knee movements.

Important Note: Before deciding on surgery, non-surgical treatment methods must be tried for a sufficient period (usually 3-6 months) and have failed (except in acute traumatic situations).

Diagnostic Methods for Kneecap Problems

A thorough understanding of the underlying problem is essential for planning the correct surgical treatment. Prof. Dr. Murat Bozkurt uses the following methods during the diagnostic process:

• Patient History: The circumstances of the first dislocation, frequency of recurrence, location and character of the pain, which activities cause problems, and previous treatments are questioned in detail.
• Physical Examination:
  
  • Observation: Leg alignment (Q angle), the position of the kneecap (patella alta/high-riding position), and muscle structure (VMO atrophy) are assessed.
  • Palpation: Tender points around the kneecap are identified.
  • Movement Examination: The tracking of the kneecap during movement (patellar tracking) and range of motion are measured.
  • Special Tests: For patellar instability, the “apprehension test,” as well as patellar tilt and glide tests, are performed. The condition of the ligaments (MPFL) is assessed.
• Imaging Methods:
  
  • X-ray: Anteroposterior, lateral, and special kneecap (axial/skyline/merchant) views are taken. The position and tilt of the kneecap, the depth of the trochlear groove, signs of osteoarthritis, and bony problems are assessed.
  • Computed Tomography (CT): Used especially to more clearly evaluate bony alignment problems and the position of the kneecap within the groove. Measurements such as the tibial tuberosity-trochlear groove distance (TT-TG distance) are taken to determine the degree of malalignment.
  • Magnetic Resonance Imaging (MRI): The most valuable method for showing cartilage surfaces, ligaments (especially an MPFL tear), tendons, menisci, and soft tissue and bone details such as bone marrow edema. It is particularly critical for determining the cause of instability and cartilage damage.

Surgical Treatment Options for the Kneecap

The surgical method to be used is determined according to the underlying problem. Prof. Dr. Murat Bozkurt selects and applies the most appropriate surgical technique for his patients in Ankara:

Arthroscopic Surgery:

• Diagnostic Arthroscopy: Directly visualizing the inside of the joint with a camera to clarify the problem.
• Debridement: Cleaning out damaged cartilage fragments or loose bodies.
• Lateral Retinacular Release: Cutting and releasing the tight ligaments (lateral retinaculum) that pull the kneecap outward. Although once commonly performed, because its results are variable when done alone and it can sometimes increase instability, it is now used more selectively or in combination with other procedures.

Patellar Instability (Dislocation) Surgery:

• Medial Patellofemoral Ligament (MPFL) Repair or Reconstruction:
  
  • MPFL: The most important soft-tissue ligament preventing the kneecap from dislocating outward; it is torn in more than 90% of dislocations.
  • Repair: Can be repaired with sutures only when the ligament has torn off the bone (avulsion) and in acute (fresh) cases.
  • Reconstruction: The standard treatment for recurrent dislocations or when repair is not possible. A new ligament is created to replace the torn MPFL, usually using a piece of tissue taken from the patient’s own hamstring tendons (autograft). This is one of the most commonly used and successful methods for treating recurrent kneecap dislocations.
• Tibial Tuberosity Osteotomy (TTO) / Transfer:
  
  • Principle: This procedure involves cutting the bony prominence (tibial tuberosity) on the shinbone (tibia), to which the patellar tendon attaches, and repositioning it. The aim is to correct the alignment of the kneecap and reduce the outward pull on it.
  • Who Is It Performed On? It is often performed together with MPFL reconstruction, particularly in patients with malalignment (such as an elevated TT-TG distance) and recurrent instability. How far the bone fragment is shifted medially, anteriorly, or distally is determined according to the patient’s anatomy (e.g., the Fulkerson osteotomy).
• Trochleoplasty:
  
  • Principle: In serious cases where the kneecap groove (trochlea) on the thighbone is congenitally shallow or flat (trochlear dysplasia), this procedure surgically deepens the groove to create a better-fitting socket for the kneecap.
  • Who Is It Performed On? This is a more complex surgery performed on selected patients with severe trochlear dysplasia in whom other methods have failed or are considered likely to be insufficient.

Patellofemoral Cartilage Surgery:

• For limited (focal) cartilage damage on the kneecap (patella) or the groove (trochlea), the methods described in the earlier “Cartilage Surgery” article (Microfracture, Mosaicplasty/OAT, Allograft Transplantation, ACI/MACI) can be applied. The method selected varies according to the size and location of the damage.

Patellofemoral Osteoarthritis Surgery:

• Tibial Tuberosity Osteotomy (TTO): In some cases, this can relieve pain by reducing pressure beneath the kneecap.
• Patellofemoral Prosthesis (Partial Knee Replacement): A partial replacement surgery in which only the joint surfaces of the kneecap and groove (trochlea) are replaced. It is an option for selected patients who have advanced osteoarthritis limited to this area while the other compartments of the knee remain healthy.
• Total Knee Replacement (TKA): If the osteoarthritis also affects other parts of the knee, total knee replacement, in which all joint surfaces are replaced, is the most appropriate solution. During TKA, the back surface of the kneecap is also usually resurfaced with a polyethylene component (patellar resurfacing).

Choosing Surgery, Risks, Benefits, and the Recovery Process

The surgical method chosen depends on the patient’s age, activity level, the underlying pathology (instability, pain, cartilage damage, osteoarthritis), anatomical factors (alignment, dysplasia), previous treatments, and the surgeon’s experience.

• Benefits: Successful kneecap surgery provides stability (preventing dislocations), reduces pain, improves knee function, and enhances the patient’s quality of life. Underlying anatomical problems can be corrected.
• Risks: As with any surgery, there are risks of infection, blood clots (DVT/PE), and anesthesia-related complications. Risks specific to kneecap surgery include persistent postoperative pain, recurrent instability (failure), knee stiffness (restricted range of motion), nerve injury (particularly to branches of the saphenous nerve, causing loss of sensation in the skin), and, after TTO, nonunion of the bone or problems with the fixation hardware (screws).
• Recovery Process:
  
  • Recovery time and the rehabilitation protocol vary considerably depending on the surgery performed.
  • After MPFL reconstruction, a brace is generally worn for a period, and weight-bearing is increased gradually. Physical therapy may last 4-9 months.
  • After tibial tuberosity osteotomy (TTO), protected weight-bearing (with crutches) is usually required for 6-8 weeks or longer for the bone to heal.
  • Rehabilitation after cartilage surgeries is much longer and more limited.
  • Recovery after patellofemoral prosthesis surgery is similar to that of total knee replacement but may be somewhat faster.
  • After all kneecap surgeries, physical therapy is critically important. Exercises are performed to strengthen the quadriceps muscle (especially its inner portion – the VMO), engage the hip and core muscles, and improve flexibility and proper kneecap tracking.

Kneecap Surgery in Ankara and Prof. Dr. Murat Bozkurt’s Approach

Kneecap problems can affect many active individuals and athletes living in Ankara. Accurate diagnosis and effective treatment of these problems require the experience of an orthopedic surgeon specialized in the patellofemoral joint.

Prof. Dr. Murat Bozkurt offers a comprehensive approach to resolving kneecap-related problems in Ankara:

• Precise Diagnostic Assessment: He determines the underlying cause of the patient’s complaints (instability, pain, cartilage damage, or osteoarthritis?) and the underlying anatomical factors (malalignment, ligament insufficiency, trochlear dysplasia) through careful examination and advanced imaging methods.
• Personalized Surgical Planning: Rather than a standard approach for every patient, he determines the surgical method (MPFL reconstruction, TTO, combined procedures, cartilage surgery, prosthesis, etc.) best suited to the patient’s individual needs, anatomy, and expectations.
• Advanced Surgical Techniques: He successfully performs modern and effective surgical techniques such as MPFL reconstruction and tibial tuberosity osteotomy.
• Focus on Rehabilitation: Recognizing that the success of surgery largely depends on postoperative rehabilitation, he directs patients to the correct physical therapy programs and closely monitors the process.

Prof. Dr. Bozkurt provides expert support to patients with kneecap problems in Ankara at every stage, from accurate diagnosis to the application of the most appropriate surgical treatment and the management of a successful recovery process.

Kneecap problems can seriously affect quality of life. However, with an accurate diagnosis and a personalized treatment plan (including surgery when necessary), it is possible to reduce pain, regain function, and return to an active life. Do not hesitate to contact Prof. Dr. Murat Bozkurt in Ankara for an expert opinion on the kneecap problems you are experiencing.

For detailed information and appointments, you can contact Prof. Dr. Murat Bozkurt at 0312 502 70 74.