Dr. Brian Cohen is a board-certified orthopedic surgeon with more than 20 years of experience, over 30,000 orthopedic surgical procedures performed, and more than 100,000 patient evaluations. He evaluates the cause of the instability, knee alignment, ligament damage, cartilage health, and activity goals before recommending treatment.
Patellofemoral instability occurs when the kneecap does not remain centered within its normal groove as the knee bends and straightens. Repeated subluxations or dislocations can cause pain, swelling, weakness, and difficulty trusting the knee during daily activities or sports. When bracing, physical therapy, and other nonsurgical treatments do not provide sufficient stability, a realignment procedure may be considered.
What Is Patellofemoral Instability?
The patella, or kneecap, sits within a groove at the lower end of the femur called the trochlear groove. As the knee bends and straightens, the patella glides within this groove. Tendons, ligaments, muscles, and the shape of the bones work together to keep it properly aligned.
Patellofemoral instability occurs when the kneecap moves partially or completely out of the groove. A partial displacement is called a patellar subluxation, while a complete displacement is called a patellar dislocation.
Instability may develop after a traumatic injury or gradually because of abnormal anatomy, ligament weakness, muscle imbalance, or poor kneecap tracking. Some patients experience a single dislocation, while others develop repeated episodes of shifting or giving way.
Symptoms of Patellofemoral Instability
Symptoms may vary depending on whether the kneecap is partially shifting, completely dislocated, or chronically unstable.
Common symptoms include:
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Pain around or beneath the kneecap
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Swelling or bruising
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A sensation that the kneecap is shifting
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Knee buckling or giving way
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Difficulty standing from a seated position
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Pain with stairs, squatting, or running
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Reduced knee motion
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Apprehension when bending or twisting the knee
An acute dislocation may also cause visible deformity, severe pain, numbness, or an inability to move the knee normally. These symptoms should be evaluated promptly.
Patellofemoral Instability Diagnosis
Diagnosis begins with a review of the patient’s symptoms, injury history, previous dislocations, and activity limitations. During the physical examination, Dr. Cohen evaluates kneecap tracking, ligament stability, range of motion, muscle strength, tenderness, and knee alignment.
X-rays may be used to assess the position of the kneecap and the shape and alignment of the bones. An MRI may help identify damage to the medial patellofemoral ligament, cartilage, meniscus, or other soft tissues. In selected cases, additional imaging may be used to measure rotational alignment or determine whether a tibial tubercle procedure is appropriate.
Treatment Options
Treatment depends on the severity of the instability, the number of previous episodes, the condition of the cartilage and ligaments, and the underlying anatomy of the knee. A first-time dislocation without a major associated injury may often be treated without surgery.
Surgery may be considered when instability continues despite appropriate rehabilitation, when the kneecap repeatedly dislocates, or when structural abnormalities make additional episodes likely.
Nonsurgical Treatment
Nonsurgical treatment may include:
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Activity modification
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Rest and ice
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Anti-inflammatory or pain-relieving medication
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A patellar-stabilizing knee brace
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Physical therapy
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Reduced knee motion
Physical therapy commonly focuses on improving quadriceps and hip strength, kneecap tracking, flexibility, balance, and movement mechanics. The goal is to reduce symptoms and improve kneecap control during daily activities and exercise.
Types of Patellar Realignment Procedures
The appropriate procedure depends on the cause of the instability. Some patients require reconstruction of damaged soft tissues, while others need correction of the alignment of the bones. Arthroscopy may be used to inspect or treat cartilage damage, but many realignment procedures also require small open incisions.
Proximal Realignment
Proximal realignment procedures address the soft tissues that help guide and stabilize the kneecap. Treatment may include releasing overly tight tissue on the outer side of the kneecap or reconstructing the medial patellofemoral ligament using graft tissue.
Medial patellofemoral ligament reconstruction is commonly considered when repeated dislocations are related to damage or weakness of this ligament.
Distal Realignment
Distal realignment changes the position of the tibial tubercle, the bony attachment point of the patellar tendon below the kneecap. Moving the tibial tubercle can improve kneecap tracking and reduce abnormal pressure across the patellofemoral joint.
Tibial Tubercle Osteotomy
A tibial tubercle osteotomy may be recommended when abnormal bony alignment contributes to recurrent instability or excessive pressure on the kneecap.
During the procedure, Dr. Cohen carefully creates a controlled cut around the tibial tubercle while keeping the patellar tendon attached. The bone segment is repositioned to improve alignment and kneecap tracking, then secured with screws while it heals.
This procedure may be performed alone or combined with ligament reconstruction, cartilage treatment, or another stabilizing procedure based on the condition of the knee.
Risks and Complications of Patellofemoral Realignment
As with any surgery, patellofemoral realignment procedures have potential risks and complications.
These may include:
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Infection
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Bleeding
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Blood clots
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Knee stiffness
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Persistent pain
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Recurrent subluxation or dislocation
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Difficulty fully straightening the knee
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Arthrofibrosis
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Nerve or blood vessel injury
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Delayed or incomplete bone healing after osteotomy
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Hardware irritation
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The need for additional surgery
The specific risks depend on the procedure performed, the patient’s health, and the severity of the underlying instability. Dr. Cohen reviews each patient’s individual risk profile before surgery.
Preoperative and Recovery Support
Dr. Cohen and his team monitor patient health, activity, and rehabilitation progress before and after surgery. Selected patients may have access to technology designed to support preparation and recovery.
Prescribe FIT (opens in new tab) may help patients improve health habits and prepare physically before surgery. The Recupe sensor from Plethy (opens in new tab) may be used to monitor participation in prescribed home exercises and track range-of-motion progress.
These tools supplement regular clinical evaluations, communication with the care team, and formal physical therapy. Availability depends on the patient’s needs and treatment plan.
Recovery After Patellofemoral Realignment
Recovery varies depending on whether treatment includes ligament reconstruction, tibial tubercle osteotomy, cartilage repair, or a combination of procedures. A brace and crutches may be needed during the early stages of healing, and weight-bearing may be limited after an osteotomy.
Physical therapy may focus on:
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Controlling pain and swelling
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Restoring knee motion
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Rebuilding quadriceps and hip strength
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Improving balance and movement control
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Protecting repaired ligaments or healing bone
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Gradually returning to work, exercise, or sports
Successful recovery requires adherence to the rehabilitation plan and allowing sufficient time for soft-tissue or bone healing. Return to higher-impact activity requires clearance from Dr. Cohen.
Why Choose Dr. Cohen?
OVER 25+ YEARS OF EXPERIENCE
One of the first orthopedic surgeons employed by a large hospital. Dr. Cohen spent 20 years.
TRUSTED BY OVER 100,000+ PATIENTS WORLDWIDE
Over his distinguished career, Dr. Cohen has cultivated a reputation of excellence and trust among his patients and his peers.
UTILIZING THE LATEST TECHNOLOGY
To achieve the best surgical outcomes, Dr. Cohen uses the most advanced technologies and techniques, keeping his practice state-of-the-art.
PATIENT SAFETY IS TOP PRIORITY
An individualized, patient-focused process coupled with decades of training and experience helps ensure maximum safety for all of Dr. Cohen’s patients.
Patellofemoral Instability Care in Chillicothe, OH
Recurrent kneecap instability can interfere with walking, exercise, sports, and confidence in the knee. Dr. Cohen evaluates ligament damage, bone alignment, cartilage health, and previous treatment before recommending nonsurgical care or a realignment procedure. Treatment is tailored to the specific cause and severity of the instability. To schedule a consultation with Dr. Brian Cohen, call (614) 788-0375.
