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Patellofemoral Instability: Is Surgery the Answer?


Many young athletes, particularly females, suffer from chronic knee pain. Pain becomes common with running, jumping, and, with later progression, even a flight of stairs. Sometimes this condition is associated with Patellar Instability, a combination of structural abnormalities and maltraking of the kneecap.

What is patellar instability?

Patellar instability is when the kneecap doesn't track properly as the result of a variety of factors:

  • Shallow trochlear groove
  • General ligamentous laxity (i.e. looseness)
  • Previous injury to supporting structures (eg. medial patellofemoral ligament)
  • Weakness in quad muscles
  • Over-activation and tightness in the hamstrings

Conservative treatment

The most immediate treatment for Patellar Instability is conservative care. Miho J. Tanaka, associate physician for the St. Louis Cardinals and Director of the Women's Sports Medicine Initiative, utilizes a variety of treatments, including:

  • Ice
  • Activity modification
  • Lateral butress (Knee Brace)
  • Anti-inflammatories
  • VMO Strengthening

These conservative treatments are commonly done in conjunction with physical therapy to promote improved quad strength to reduce compression forces under the kneecap. Educating an athlete about appropriate mechanics with squatting, lunging, and jumping exercises is important to reduce the maltracking and abnormal pressure associated with patellar instability.

Surgical options

If conservative treatment fails, surgical options may be considered. One surgery is medial patellofemoral ligament (MPFL) reconstruction. This particular operation improves the tracking and stability of the patella, therefore reducing pain and unnecessary "wear and tear" on the knee. Dr. Tanaka, through clinical, surgical, and research experience, has determined that if conservative treatments have failed, MPFL reconstruction surgery offers young athletes a better chance of returning to athletic excellence.

Chronic knee pain is red flag

As with any medical condition, having your child evaluated by a medical professional is essential if your child has the following:

  • History of chronic knee instability
  • Previous dislocation
  • Pain with common movements such as stairs or walking
  • Increased joint laxity throughout the body

An orthopedic surgeon with a specialized background in chronic knee pain should conduct the examination.  While most athletes will require only conservative treatment, it is important to note that early intervention is essential! Loss of cartilage and development of chronic pain are more difficult to treat as the months and years pass. Commonly, pain associated with chronic knee pain is Patellofemoral Syndrome, which through conservative treatment often results in less pain and improved athletic performance. An experienced physician can differentiate between these two conditions and put your child back on track to athletic success.

Dr. Cronin gratefully acknowledges the assistance of Miho J. Tanaka, MD, Director of Women's Sports Initiative at Regeneration Orthopedics and Associate Team Physician for the St. Louis Cardinals, in the preparation of this article.