Patellofemoral Disorders in Jaipur

What patellofemoral disorders are and how they happen

Your kneecap (patella) normally slides up and down inside a vertical groove at the end of your thighbone (femur) when you bend and straighten your leg. A network of tendons and ligaments holds the kneecap in this groove. Patellofemoral disorders happen when the kneecap moves out of this groove or does not track smoothly.

The kneecap can pop completely out of the groove, which is called a dislocation, or it can partly slip out, which is called a subluxation. Most often the kneecap moves to the outer side of the knee. When the kneecap dislocates it locks the knee and pulls the ligaments out of place, often tearing them.

A patella dislocation is different from a knee dislocation, which involves the thighbone and shinbone and is a much more serious injury. Patellofemoral disorders also include maltracking, where the kneecap does not sit centrally in the groove, and chondromalacia, which is softening or wear of the cartilage under the kneecap.

Symptoms and warning signs that need urgent care the same day

A dislocated kneecap is painful and stops you from walking. You will not be able to use the leg normally until the joint is corrected. The knee may be locked and unable to straighten or bend, or it may catch and pop when you try to move it.

The joint feels unstable and may buckle when you put weight on it. There is usually a large swelling (effusion) and tenderness along the inner side of the knee. A tense, swollen knee often means there is blood in the joint (haemarthrosis).

If the kneecap pops back into place on its own, the knee will still be sore and swollen from the trauma. You should seek care the same day if you cannot straighten the knee, if the knee looks deformed, if you cannot bear any weight, if the swelling appears rapidly, or if you have numbness or tingling in the foot.

These signs may mean:

• A fracture
• A trapped loose piece of bone or cartilage
• Nerve or blood vessel injury that needs immediate attention

Causes and who is at higher risk

A direct blow or a fall can knock the kneecap out of place. A sudden twist of the knee while the foot stays planted on the ground can also cause it. Some people are born with a shallow groove (trochlear dysplasia) or other structural differences that make the kneecap unstable. A family history suggests a genetic link for congenital dislocation.

Risk factors include:

• Being young
• Female
• Having loose ligaments
• A high-riding kneecap (patella alta)
• A tibial tubercle that sits too far to the outer side

A previous dislocation on the other knee raises the risk of recurrence six-fold. After a second dislocation the chance of another episode is much higher, around 49%. Up to 45% of people who have had one dislocation will dislocate again. Articular cartilage injuries are very common, occurring in up to 95% of first-time dislocations.

How patellofemoral disorders are diagnosed: examination and tests

A doctor can usually diagnose a dislocated kneecap by examining your knee and asking about the injury. The physical examination checks for swelling, tenderness on the inner side, and how the kneecap moves. The doctor will also test the ligaments and check the alignment of your leg.

X-rays (anteroposterior, lateral and axial views) are taken first to see the kneecap position and look for a bone fragment. X-rays can miss cartilage injuries, so an MRI is often needed to see the joint surfaces, ligaments and any loose pieces. MRI reliably shows osteochondral injuries in first-time dislocators. If there is a large haemarthrosis, MRI is especially indicated.

A CT scan may be used to measure the tibial tubercle-trochlear groove (TT-TG) distance, which helps plan surgery. MRI can also measure TT-TG distance, but the values may not be interchangeable with CT.

Treatment options without surgery and when surgery is advised

First-time dislocations without a displaced bone fragment are usually treated without surgery. The knee is rested, iced and elevated. A brace or cast in extension may be used for a period, often around six weeks, followed by physiotherapy to regain movement and strengthen the quadriceps. Some studies used shorter periods of immobilisation, but a higher redislocation rate may result.

Pain relief with NSAIDs is common. Most people return to daily activities in six to eight weeks and to sports in three to four months. Surgery is considered when there is a displaced osteochondral fragment large enough to fix (usually with at least 9 mm of bone).

Surgery may also be advised after recurrent dislocations, when the kneecap remains unstable despite rehabilitation, or when there are structural problems such as a very shallow groove or a high TT-TG distance.

Your surgeon will discuss which procedure suits your anatomy, such as:

• MPFL reconstruction
• Tibial tubercle osteotomy
• Lateral release or trochleoplasty

Preparing for patellofemoral surgery

Before surgery, your surgical team will ask for a set of investigations. These usually include blood tests, a chest X-ray and an ECG to check your fitness for anaesthesia. Imaging of the knee is essential. You will typically have an MRI to look at the cartilage, ligaments and any loose fragments.

A CT scan may also be requested to measure the tibial tubercle-trochlear groove distance, which helps the surgeon plan the procedure.

Tell your surgeon about every medicine you take, including blood thinners, diabetes tablets, insulin and any supplements. Some medicines may need to be stopped a few days before the operation. If you have a fever, cough, skin infection or any new illness in the week before surgery, call the hospital — the date may need to move.

You will be asked to fast for at least six hours before the procedure. This means no food, milk or tea. You may sip a small amount of water with your usual morning tablets if the anaesthetist has agreed. Bring your regular medicines, a list of allergies, your insurance or scheme cards and a photo ID.

Pack loose, comfortable clothing that fits over a bulky knee dressing, and a pair of flat, supportive shoes. An attendant should plan to stay with you for the first night after discharge.

How patellofemoral surgery is done

The operation is performed under spinal or general anaesthesia and usually takes one to two hours. Most patients stay in hospital for one to two nights. The exact procedure depends on the underlying problem — instability, maltracking or cartilage wear — and your surgeon will advise which option suits you.

• MPFL reconstruction: The medial patellofemoral ligament is rebuilt using a tendon graft. This is the common choice for recurrent dislocation where the ligament is torn or stretched.
• Tibial tubercle osteotomy (Fulkerson): The bony attachment of the patellar tendon on the tibia is cut and shifted medially and forward. This offloads worn cartilage and corrects maltracking.
• Lateral release or lengthening: Tight tissues on the outer side of the knee are divided arthroscopically to reduce excessive lateral pressure.
• Trochleoplasty: The groove at the end of the thigh bone is deepened to hold the kneecap more securely. This is reserved for severe trochlear dysplasia.

Sometimes two procedures are combined, for example MPFL reconstruction with a tibial tubercle osteotomy. On the day of surgery you will be admitted to the ward, meet the anaesthetist, and sign the consent form. After the operation you will wake up in the recovery area with a bulky bandage and a knee brace.

Pain relief is given through injections or tablets. The nursing team will check your circulation and sensation in the foot regularly. You will start gentle ankle and toe movements straight away. A physiotherapist will teach you how to use crutches and how much weight you may put on the leg before you go home.

Risks and possible complications of patellofemoral surgery

All operations carry some risk. In a large review of MPFL reconstruction, complications were reported in 26.1 percent of knees (164 complications in 629 knees).

The events ranged from minor to major and included:

• Patellar fracture
• Graft failure
• Persistent instability on examination
• Loss of knee flexion
• Wound problems and pain

Twenty-six patients needed a second operation.

Other known risks include stiffness, weakness and loss of muscle control that can follow prolonged immobilisation. Long-term, the joint may develop osteoarthritis, especially if the cartilage was damaged at the time of the original dislocation. Recurrent dislocation remains possible after surgery, particularly if you return to high-risk sports too early or if the underlying bony anatomy is severely abnormal.

Your surgical team will discuss the risks that apply to your specific procedure and anatomy. They will also explain the steps taken to reduce complications, such as careful surgical technique, early mobilisation and a structured rehabilitation programme.

Recovery and aftercare after patellofemoral surgery

In the first few days you will manage swelling with ice, elevation and the prescribed pain tablets. Keep the dressing clean and dry. You will walk with crutches, putting only the amount of weight your surgeon allows. The knee brace is usually worn full-time for the first few weeks, then gradually reduced as your quadriceps control returns.

Stitches or clips are removed at about two weeks. Physiotherapy starts early with range-of-motion exercises and static quadriceps work. Over the next weeks you progress to weight-bearing exercises, cycling and strengthening. Most people return to daily activities by six to eight weeks.

Return to sport typically takes three to four months after non-surgical treatment, but after surgery it may take longer — often more than a year for high-level sport. The protocol at Jaipur Hospital expects return to activity in four to six months.

Call the hospital or attend the emergency department if you notice:

• Increasing redness, warmth or discharge from the wound
• A sudden increase in pain not relieved by tablets
• Calf swelling or tenderness
• Fever above 38°C
• If the knee gives way repeatedly

Keep your follow-up appointments so the team can check healing and adjust your rehabilitation plan.

Results of patellofemoral surgery: how well it works and recurrence

Studies show that MPFL reconstruction significantly improves patient-reported outcome scores. In a pooled analysis, the Kujala score — a questionnaire about knee function — increased by an average of 26.4 points after surgery. The mean preoperative score ranged from 50 to 70, and postoperative scores reached around 79 in some series. Functional outcomes remain favourable as complication and failure profiles have improved over time.

Redislocation rates after MPFL reconstruction are low in recent studies, with functional failure rates dropping from 9.5 percent in older reports to 4.8 percent in newer ones. However, the likelihood of preventing redislocation appears higher when trochleoplasty is combined with extensor apparatus balancing for severe dysplasia. No single fixation technique or graft choice has been shown to give better functional outcomes than another.

For first-time dislocations, randomised trials have not shown a clear benefit of early surgery over bracing and physiotherapy in terms of final function or activity levels, although some studies report fewer redislocations with surgical repair. After a second dislocation the risk of further episodes rises substantially, and surgery is often considered. Your surgeon will weigh the evidence against your age, activity goals, imaging findings and the number of previous episodes.

Cost and insurance for patellofemoral surgery in Jaipur

The typical price range for patellofemoral realignment surgery at Jaipur Hospital is ₹1,20,000 to ₹3,00,000.

The final amount depends on:

• The procedure performed — MPFL reconstruction, tibial tubercle osteotomy, lateral release, trochleoplasty or a combination
• The type of implants or grafts used
• The length of stay
• Whether you have any additional medical conditions that need care during admission

Ask the admissions desk for a detailed estimate before you are admitted.

Jaipur Hospital is empanelled under RGHS, MAA Yojana and CGHS, and works with a panel of private insurers and TPAs. If you are covered by one of these schemes, bring your scheme card and any pre-authorisation letter. The billing team will help you understand what is covered and what you may need to pay out of pocket. The hospital has an in-house pharmacy and diagnostic laboratory, so medicines and tests during your stay are billed directly.