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Patellofemoral Stabilisation

Restoring stability to a kneecap that won't stay in place — discover the options, procedure and recovery for patellofemoral stabilisation surgery.

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Overview

The treatment for patellofemoral instability / dislocation depends on the underlying problem. If it’s the first time you’ve had a dislocation, then we will carry out an assessment and perform a course of physiotherapy. Physiotherapy focuses on strengthening and improving control in the muscles around the knee to help stabilise the kneecap, while bracing and NSAIDs can offer additional support and pain relief along the way. Around 50% of patients go on to heal and have little or no further problems.

Where instability becomes recurrent, further investigation is undertaken to identify the specific underlying cause. Depending on the findings, management may involve one or a combination of surgical procedures:

  • MPFL reconstruction — restoring the primary stabilising ligament on the inner side of the knee.
  • Tibial tubercle transfer — repositioning the bony attachment of the patellar tendon to correct patellar height and alignment.
  • Trochleoplasty — reshaping the trochlear groove to improve patellar tracking.
  • Lateral release — dividing part of the lateral retinaculum, the thick band of tissue on the outer side of the patella, to allow it to move more freely.

It's important to follow your treatment plan as directed to help ensure the best possible outcome

The Procedure

MPFL Reconstruction

This procedure involves reconstructing the medial patellofemoral ligament (MPFL) — the ligament that holds the kneecap in central alignment and acts as its main stabilising check. Reconstruction can be performed using one of the patient's own tendons (typically a gracilis autograft), an allograft tendon or a synthetic graft material. Patients are generally able to fully weight-bear with the support of crutches, with recovery taking around six weeks.

Tibial Tubercle Transfer

This is a larger procedure in which the front of the knee is exposed to access the tibial tubercle — the point on the shin bone where the patellar tendon attaches. As instability can sometimes stem from this attachment sitting too far laterally, or the kneecap sitting too high, the bone fragment is carefully osteotomised, repositioned to allow more central or lower tracking of the kneecap, and secured back in place with a plate and screws. Recovery takes around 12 weeks while the bone heals, with patients kept on partial (50%) weight-bearing with crutches for the first six weeks, progressing to full weight-bearing with or without crutches thereafter.

Trochleoplasty

This is the more complex of the surgical options for patellofemoral instability. The procedure aims to deepen the groove beneath the trochlear cartilage of the femur, allowing the kneecap to sit securely and glide smoothly down the groove rather than shifting to one side. Mr Barkatali is currently the only surgeon in the UK performing this procedure arthroscopically — through keyhole surgery — rather than via the standard open approach, resulting in significantly less scarring and potentially improved outcomes. Patients are able to fully weight-bear with the support of crutches, with recovery taking around 12–24 weeks.

Lateral Release

This procedure involves dividing part of the lateral retinaculum — the thick band of tissue running along the outer side of the kneecap — to release excessive tension pulling the patella off-centre. By loosening this structure, the kneecap is able to track more centrally within the trochlear groove. Lateral release is often performed alongside other stabilising procedures rather than as a standalone treatment. Recovery is generally quicker than the more complex reconstructive options, with most patients able to fully weight-bear with crutches from an early stage.

Outcomes

  • 20+ years of experience
  • 5000+ surgeries
  • <1% complication rate

Healing Begins Here

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At The Knee Clinic, we specialize in innovative solutions for knee-related issues. Our dedicated team is committed to providing personalized care that addresses your unique needs, ensuring you receive the best possible outcomes

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<1%

Complications rate

5000+

Operations

20+

Years of Experience

Frequently asked questions

The main goal is to restore normal tracking and stability to the kneecap, significantly reducing the risk of further dislocation, relieving pain, and allowing a return to normal activity and sport with confidence. Addressing the underlying cause — rather than just treating symptoms — offers the best chance of a lasting solution.

Surgery duration depends on which procedures are required. An isolated MPFL reconstruction typically takes around 60 minutes, while combined procedures, such as MPFL reconstruction with a tibial tubercle osteotomy, take longer, around 90–120 minutes.

The surgery can be carried out under general anaesthesia (where you're fully asleep).

As with any surgery, there are risks to be aware of, including:

  • Infection
  • Bleeding
  • Pain
  • Stiffness
  • Damage to nearby blood vessels or nerves
  • Recurrent instability or dislocation
  • Graft failure (in MPFL reconstruction)
  • Need for further or revision surgery

Mr Barkatali will discuss how these risks apply to your specific case and planned procedure.

Wounds are typically closed with stitches and/or skin clips. You’ll usually have a wound check with the nurses at the hospital around 2 weeks after surgery to make sure everything is healing well, and any stitches or clips will be removed.

Yes — a knee brace is typically worn for the first few weeks after surgery to protect the reconstruction while it heals, particularly if a tibial tubercle osteotomy has been performed. Your brace settings will be gradually adjusted to allow increasing movement as your rehabilitation progresses. Mr Barkatali and your physiotherapist will guide you on the right timeline for your specific procedure.

An isolated MPFL reconstruction is often carried out as a day case or with one night's stay. If combined with a tibial tubercle osteotomy, a short hospital stay of 1 night is more typical, as recovery from the bony procedure takes slightly longer to settle initially.

Recovery varies depending on which procedures were performed. Following MPFL reconstruction alone, most patients use crutches for around 1–2 weeks before progressing to full weight-bearing as comfort allows. If a tibial tubercle osteotomy is also performed, a period of protected or restricted weight-bearing — usually around 6 weeks — is needed to allow the bone to heal. Physiotherapy plays a key role throughout, helping to restore strength, movement, and confidence in the knee.

Generally, once you can walk comfortably without crutches or a walking aid and can perform an emergency stop safely, you’re ready to drive again. This is typically sooner after an isolated MPFL reconstruction, and later if a tibial tubercle osteotomy has also been carried out, given the need to protect the healing bone.

Flying is usually fine from around 6 weeks after surgery, provided you're otherwise fit and take sensible precautions, such as staying hydrated and moving regularly during the flight.

This depends on the physical demands of your job and which procedures were performed. Many patients return to desk-based work within 2–4 weeks, while more physical roles, or recovery following a tibial tubercle osteotomy, may take 2–3 months.

Return to sport is gradual and guided by your rehabilitation progress rather than time alone. Low-impact activity such as swimming and cycling is usually encouraged from around 6–8 weeks, with running typically reintroduced from around 3 months. A full return to pivoting or contact sports is generally not recommended until 6–9 months, once strength, control, and confidence in the knee have been thoroughly assessed.

Yes — physiotherapy is a vital part of recovery, helping to restore strength, movement, and — importantly — confidence in the knee, which plays a significant role in preventing further instability. Your physiotherapist will work closely with you and Mr Barkatali to guide a staged return to full activity.

Pain, swelling, and stiffness are normal in the first few weeks and are managed with pain relief medication, ice, and elevation. This generally settles steadily as rehabilitation progresses.

Outcomes are generally good, with the large majority of patients experiencing a significant reduction — or complete resolution — of instability episodes, along with improved confidence and function in the knee. As with any stabilisation procedure, success depends on correctly identifying and addressing the underlying cause of your instability, which is why thorough pre-operative assessment is so important. However, patients who have patellofemoral instability are predisposed to abnormal biomechanics in the patellofemoral part of the knee joint and are more likely to have ongoing pain and develop osteoarthritis later in life.

You’ll typically attend a pre-operative assessment to check your fitness for surgery, along with routine blood tests. Detailed imaging — usually MRI and sometimes CT — will already have been carried out to plan your surgery precisely. Prehabilitation, involving physiotherapy to strengthen the muscles around the knee, is also recommended and can support a smoother recovery.

Not necessarily on the first dislocation — many first-time dislocations are managed non-surgically with physiotherapy and rehabilitation. Surgery is generally considered after recurrent dislocations, or where imaging identifies a significant underlying structural cause that makes further instability likely. Mr Barkatali will assess your individual pattern of instability and imaging findings to determine whether surgery is the right option for you.

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