A repeatedly dislocating kneecap may not only keep you out of sport; it could also increase your long-term risk of osteoarthritis. YKC’s Jim Newman has been to Berlin to explore best-practice stabilisation techniques that can stop patellar dislocation for good.

Here’s how your kneecap should work: a small, flat, rounded bone (the patella) sits at the front of your knee within a groove at the end of the thighbone. The patella tracks along that groove, helping you extend and bend your leg, and helping to protect the knee joint behind it.

Sometimes, however, things don’t work quite the way they should. It’s possible to dislocate the kneecap, just as you might with a shoulder. For some people, the knee joint doesn’t fully develop and the patella can keep popping out of too shallow a groove.

Knee surgeons call this ‘patellar instability’.

> What Is Osteoarthritis & How Do You Treat It?

How does patellar instability affect patients?

For such a small part of the body, patellar instability can have surprisingly far-reaching consequences. At first instance, this might include pain, swelling, difficulty walking, and limited knee function. If the kneecap repeatedly dislocates, it can damage cartilage and increase the risk of osteoarthritis. And if chronic (that is, ongoing) patellar instability stops you doing the things you love, like taking part in sport, it can affect general fitness and mental wellbeing too.

Patella stabilisation

One way knee surgeons address patellar instability problems is with a procedure called patella stabilisation, and one of the very best at this particular procedure is Arno Schmeling, a Berlin-based surgeon. Recently, I was in Berlin to understand more about Arno’s approach to the procedure.

Like all knee surgeons, I learned patella stabilisation techniques when I was in my fellowship years. Although we regularly see patients with patella instability, the number of patients for whom that instability is caused by a shallow groove was very small. In recent years, however, we’ve seen numbers increasing (a combination of population growth and an improved ability to spot patella problems through MRI scans), so it was important for me to explore new techniques to augment existing options like ligament strengthening.

In simple terms, stabilisation involves removing the gliding cartilage from the front of the knee to expose the groove. Then the groove is deepened before everything is put back where it was.

It’s a very impressive operation but perhaps the most technically challenging patella procedure, so it was extremely valuable to learn from the best.

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“Why didn’t I get this done ten years ago?”

I typically see two sorts of patients about kneecap stability surgery. One will have had the kneecap damaged through some sort of trauma, such as a sports injury. These patients rarely have any underlying problems and can often do well without any surgery.

The other group are patients who have an underlying problem that allows the knee cap to dislocate. Physiotherapy would usually be the first treatment of choice. If, having supervised progress, things don’t improve, surgery may well be recommended.

Treatment is personal – it certainly isn’t a one-size-fits-all scenario. We look at it holistically, but with the aim of avoiding the situation where someone curtails sport only to have surgery years later and think to themselves, “Why didn’t I get this done ten years ago?”

If that’s you, it really is important to get this looked at to ensure you’re doing the right thing for your age and activity level to avoid early onset arthritis.

To explore your treatment options, contact us, or phone us on 03453 052 579.

> Find out more about Jim Newman
> What Is Osteoarthritis & How Do You Treat It?
> Discover more about osteoarthritis, YKC & you