What is Patellar Dislocation Surgery

Patellar Dislocation Surgery is a procedure to repair your kneecap (patella) if it slips in and out of its normal groove (subluxation), or if it slips out and stays out of place (dislocation). If this happens often, your knee may buckle and not be able to support your weight (patellar instability).

Knee movement depends on strong bands of tissue (ligaments) working together to keep your patella in its normal place. One ligament attaches your patella to your thigh muscles above and to your shin bone below. Other ligaments attach your patella to the inside and outside of your knee.

During this procedure, these ligaments will be repaired in a way to keep your patella in place. The exact surgery you have depends on your type of knee instability. You may have arthroscopic surgery. This surgery is done through several small incisions using a thin, lighted telescope with a camera (arthroscope). You may also have an open repair, which is done through one larger incision.

You may have a procedure:

• To loosen or tighten the patellar ligaments on the inside or outside of your knee.
• To replace a patellar ligament with a type of connective tissue that connects muscles to bones (tendon). Tendons may be stronger than ligaments. A tendon from one of your thigh muscles may be used for this procedure.
• To move the area where your patella tendon attaches to your shin bone (tibial tubercle transfer).

This surgery may involve a combination of these procedures and other procedures. You may need this surgery if nonsurgical treatments have not cured your knee instability.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to nerves or blood vessels.
• A blood clot that forms in the leg and travels to the lungs (pulmonary embolism).
• Loss of knee strength.
• Loss of knee movement (arthrosis).
• Procedure failure.

What happens before the procedure?

Stay hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours – stop eating light meals or foods, such as toast or cereal.
• 6 hours – stop drinking milk or drinks that contain milk.
• 2 hours – stop drinking clear liquids.

General instructions

• You may have a physical exam before the procedure. This may include X-rays.
• Ask your surgeon about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your surgeon instructs you not to.
• Plan to have someone take you home from the hospital or clinic.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• If you are having arthroscopic surgery:
  • Several small incisions will be made near your knee.
  • A clear, germ-free fluid will be injected into your knee through one incision to help your surgeon see inside the joint.
  • The arthroscope will be inserted through another incision. The camera on the scope will send images to a TV screen in the operating room. Your surgeon will use those images to guide the surgery.
  • Surgical instruments will be inserted through the other incisions to repair the ligament.
  • The instruments and the scope will be removed when the procedure is complete.
  • Your knee joint will be flushed out with the fluid.
  • Your surgeon will close the incisions with small stitches (sutures) or adhesive strips.
  • One bandage (dressing) will be placed over your knee, and another will be wrapped around your knee.
• If you are having an open repair:
  • Your surgeon may place a tourniquet above your knee.
  • An incision will be made over the front of your knee to expose the patella and ligaments.
  • The ligament repair will be done through the incision.
  • The tourniquet will be removed.
  • The skin incision will be closed with sutures or staples.
  • One dressing will be placed over your knee, and another will be wrapped around your knee.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• Your IV can be removed when you are able to eat and drink on your own.
• You will be given medicine for pain.
• You will be given crutches or a walker to help you move around.
• You may need to wear a knee brace.
• Do not drive for 24 hours if you received a sedative.

Patellar Dislocation Surgery, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain.
• Swelling.
• Bruising.

Follow these instructions at home:

If you have a brace:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the brace if your toes tingle, become numb, or turn cold and blue.
• Do not let your brace get wet if it is not waterproof.
• Keep the brace clean.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• If your brace is not waterproof, cover it with a watertight plastic bag when you take a bath or a shower.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Managing pain, stiffness, and swelling

• If directed, apply ice to your knee.
  • Put ice in a plastic bag.
  • Place a towel between your skin, cast, or brace and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your toes often to avoid stiffness and to lessen swelling.
• Raise (elevate) your knee above the level of your heart while you are sitting or lying down.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Do not drive for 24 hours if you received a sedative.
• Ask your health care provider when it is safe to drive.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

Safety

• Do not use your leg to support your body weight until your health care provider says that you can. Use your crutches or walker as told by your health care provider.

General instructions

• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have chills or a fever.
• Your pain is not controlled with your pain medicine.
• You have signs infection at your incision site.
• Your toes tingle, become numb, or turn cold and blue.

Get help right away if:

• You have severe pain.
• You have chest pain.
• You have difficulty breathing.