What is it?

Patellar realignment surgery corrects recurrent dislocations or instability of the kneecap.

The goal is to restore proper tracking of the patella within the groove at the end of the femur, known as the trochlea.

Procedures may involve soft tissue realignment, such as tightening or reconstruction of the medial patellofemoral ligament, bony realignment, such as shifting the tibial tubercle, or both, depending on the cause.

What happens when it occurs?

When the kneecap does not track properly, it may slip out of place or feel like it is about to.

This often happens during twisting or sudden changes of direction.

Instability can damage cartilage, raise the risk of arthritis, and prevent return to sport.

Surgery re-centres the patella to improve stability and lower the risk of further injury.

Common causes and risk factors

  • Shallow or abnormally shaped trochlear groove
  • General ligament looseness
  • Previous patellar dislocations
  • Reduced quadriceps or hip strength
  • Young age, especially adolescents, in sport

Who is most affected?

Active adolescents and young adults with recurrent dislocations or ongoing instability, especially in sports with pivoting or contact.

Typical symptoms

  • Kneecap giving way during twisting or turning
  • Pain around the front of the knee
  • Swelling after dislocations
  • Fear of the knee slipping out during activity

When to consider surgery

  • Recurrent dislocations despite rehabilitation
  • Persistent instability that limits daily life or sport
  • Structural issues visible on MRI or X-ray
  • Cartilage damage that needs surgical correction

How surgery is performed

The specific procedure depends on the cause of the instability.

MPFL reconstruction uses a tendon graft to stabilise the patella.

Tibial tubercle osteotomy moves the bony attachment of the patellar tendon to improve tracking.

Trochleoplasty reshapes the groove in severe cases.

Many steps are done arthroscopically with small incisions. Patients may go home the same day or after one night in the hospital.

Rehabilitation after surgery

At Spinal and Sports Care, rehabilitation focuses on safe and stable function.

Early phase, zero to six weeks: pain and swelling control, restoring knee extension, controlled flexion, and gradual weight bearing, sometimes with brace protection.

Intermediate phase, six to twelve weeks: quadriceps strengthening, hip and core stability, and balance training.

Advanced phase, three to six months: sport-specific drills, jumping, and change of direction practice.

Return to sport, six to nine months: strength, hop testing, and functional clearance before return.

Prevention of recurrence

  • Ongoing hip, core, and quadriceps strengthening
  • Neuromuscular control training
  • A progressive return to sport plan with supervision

Latest insights

Evidence supports MPFL reconstruction as a reliable option for recurrent instability in young patients.

Combining surgery with structured rehabilitation reduces the chance of redislocation.

New imaging methods are improving the ability to plan surgery to match each person’s anatomy.

Frequently Asked Questions

Timeframes depend on the procedure and your starting capacity. We progress when pain is controlled, swelling is down, and movement and strength targets are met. Expect a structured plan and criteria to guide you more than the calendar.

Yes, inside your plan. Keep pain during activity at or below 3 out of 10 and ensure it is no worse than the next morning. Use supports and aids as directed.

Imaging is used in conjunction with surgical decisions or when progress stalls. Your clinician will advise on whether an X-ray, ultrasound, CT scan, or MRI is most useful.

They protect healing tissue in early phases. We reduce support as control and strength improve, then remove them for strengthening and gait retraining. You will be guided by your surgeon and health care practitioner.

Ice helps early when swelling and pain dominate. Heat helps later when stiffness is the main issue.

If the pain is 2 out of 10 or less the next morning, swelling is stable, strength is within 90 per cent of the other side, and you pass your functional tests for the procedure.

Cut the next session’s volume by 20 to 30 per cent, keep your strength work, elevate and ice, then retest the following day.

Most people return in stages. Drive when you can load and move the knee safely and brake firmly without pain, and when medications do not impair you. Your clinician and surgeon will provide guidance.