Patellofemoral reconstruction

What is Patellofemoral reconstruction?

Most often, patellofemoral syndrome is treated with a specific muscle strengthening program under the guidance of a physiotherapist.  If surgery is required, a number of procedures may be offered, commonly iliotibial band (ITB) release with or without patellofemoral reconstruction.  The iliotibial band  is a strong fibrous band on the lateral (outside) side of the knee which pulls the patella sideways.    If instability is present, the ITB release is then combined with reconstruction of the medial retinacular structures which act to pull the patella medially, or the opposite direction of the ITB.  Further procedures may be required; if so, these will be discussed prior to surgery.

 

How can Patellofemoral reconstruction help?

The goal of patellofemoral reconstruction is to stabilise an unstable or potentially unstable joint, and to decrease stress on the patellofemoral joint. Joint stabilisation has been shown to decrease articular cartilage injury. This then decreases the likelihood of later osteoarthritic change. It also allows return to activities that were difficult secondary to joint instability or activities that increased forces on the patellofemoral joint.

What sort of anaesthetic is used?

Almost all patellofemoral reconstruction surgery is done on an outpatient basis. The surgery can be performed under regional or general anesthesia. Regional anesthesia numbs below the waist, whereas general anesthesia puts to sleep. The anesthetist will help determine which is the most suitable.

What should I expect after the Patellofemoral reconstruction ?

Most patients experience only mild discomfort when they wake up after a patellofemoral reconstruction.

Recovery from surgery is much faster than recovery from traditional open knee surgery. Still, it is important to follow the instructions carefully and be checked on the first evening.

The wounds will be dressed with waterproof dressings under the outer bandage. A knee brace will be applied if bone transfer was part of the surgery.  The outer bandage may be removed 24hrs after surgery.  The smaller dressing is to remain intact for 7-10 days.

 

How Long will it take to recover?

Unless instructed otherwise, weight bearing as comfort allows is recommended immediately after the surgery. Crutches may be used for comfort where necessary, and are usually required for 2-3 days. Most patients are walking reasonably comfortably by 2 weeks and can generally commence running by 6 weeks.  It is important not to over-exert too early after the procedure as this can increase the discomfort and swelling. Gradual reintroduction of activities within comfort levels is recommended. Driving a car is allowed day 2 unless the surgery was on the right knee. People with desk jobs can return to work as early as 2-3 days, while people in more heavy manual employment may require 6 weeks. The rehabilitation program runs over a 12 month period.

Is physiotherapy required after Patellofemoral reconstruction ?

Physiotherapy should ideally commence preoperatively. Patients who have a pain-free, mobile, healthy joint recover far quicker post operatively than those patients with acutely painful joints. It is helpful to be familiar with the required exercises pre-operatively.

Physiotherapy is then commenced immediately post operatively. A physiotherapist will supervise muscle contractions, walking and weight bearing. Physiotherapy will continue on a daily basis following surgery until the dressings are removed after 7-10 days. Sedentary and office workers may return to work approximately 2-3 days following surgery. Most patients should be walking normally 7 days following surgery although there is considerable patient to patient variation.

 

What are the risks?

Patellofemoral reconstruction is a very safe procedure. The most common side effect is temporary discomfort or slight bruising.

As with all operations if at any stage anything seems amiss it is better to call the rooms for advice rather than wait and worry. A fever, or redness or swelling around the line of the wound, an unexplained increase in pain should all be brought to the attention of the surgeon.

Potential postoperative problems with patellofemoral reconctruction include infection, blood clots, and an accumulation of blood in the knee. These occur infrequently. Rarely the surgery may not stop the patella instability and further surgery may be required