Patellar Malalignment: Surgery Options and Recovery Insights

Patellar valgus (dislocation)

Hello: A car accident in July led me to have an X-ray of my knee.
The doctor diagnosed me with significant patellar valgus in both legs.
After three months of conservative treatment, including quadriceps training, there was no improvement upon follow-up.
Therefore, the doctor suggested performing arthroscopic surgery to release the ligaments on the other side of the joint to restore elasticity.
I would like to know if there is a necessity for surgery or if there are other solutions available.
If I undergo surgery, will I be able to fully recover, and is there a risk of recurrence? Are there any potential side effects after the surgery? I have many questions and would appreciate your help! Thank you~~^^

AMANDA, 20~29 year old female. Ask Date: 2003/11/13

Dr. Shi Guozheng reply Orthopedics

Patellar valgus that is asymptomatic does not require treatment.
If symptoms are present, conservative treatment and strength training can be initiated to improve the condition.
It is also advisable to avoid squatting or kneeling, and to reduce activities such as going up and down hills, climbing stairs, or hiking.
Arthroscopic surgery may alleviate symptoms in some patients, but it does not guarantee complete resolution.
This depends on whether the patient's pain is solely due to malalignment of the knee.
If not, surgery may not lead to improvement.
If there is already cartilage wear, performing surgery alone will be ineffective; such cases have been reported in the literature.
Therefore, a thorough evaluation is necessary to ensure there is no cartilage wear or chondromalacia before considering surgery, as proceeding without this assessment could be futile.
It is recommended that you seek evaluation from other physicians and measure the angle of valgus, as well as the distance between the center of the patella and the femur, before making a decision.

Reply Date: 2003/11/13

More Info

Understanding patellar malalignment is crucial for determining the appropriate treatment options and recovery expectations. Patellar malalignment, often characterized by conditions such as patellar tilt or patellar tracking issues, can lead to pain, instability, and functional limitations in the knee. In your case, the diagnosis of significant patellar malalignment following a car accident, coupled with the ineffectiveness of conservative treatments like quadriceps strengthening exercises, raises important considerations for surgical intervention.

Surgical Necessity and Options
When conservative treatments fail to yield improvement, surgery may become a viable option. The procedure your doctor suggested—arthroscopic surgery to release tight ligaments—aims to restore proper alignment and function of the patella. This type of surgery can be beneficial, especially if the malalignment is causing significant pain or functional impairment.

However, before proceeding with surgery, it is essential to weigh the potential benefits against the risks. Other non-surgical options may still be explored, such as:
1. Physical Therapy: A tailored physical therapy program focusing on strengthening the muscles around the knee, particularly the quadriceps and hamstrings, can sometimes improve alignment and reduce symptoms.

2. Bracing: A knee brace may help stabilize the patella and improve tracking during activities.

3. Activity Modification: Avoiding activities that exacerbate the condition can also be beneficial.

4. Injections: Corticosteroid or hyaluronic acid injections may provide temporary relief and improve function.

Recovery and Prognosis
If you decide to proceed with surgery, the recovery process typically involves:
- Initial Rest and Rehabilitation: Post-operative rehabilitation is crucial. You will likely begin with gentle range-of-motion exercises, progressing to strengthening exercises as tolerated.

- Physical Therapy: Engaging in a structured physical therapy program can significantly enhance recovery and help restore function.

- Time Frame: Full recovery can take several months, and while many patients experience significant improvement, individual outcomes can vary based on factors such as age, activity level, and adherence to rehabilitation protocols.

Risks and Complications
As with any surgical procedure, there are risks involved, including:
- Infection: Though rare, infections can occur post-surgery.

- Blood Clots: There is a risk of developing blood clots in the legs after surgery.

- Persistent Pain or Instability: Some patients may continue to experience pain or instability even after surgery.

- Recurrent Malalignment: There is a possibility that the malalignment could recur, especially if the underlying causes are not addressed.

Conclusion
In summary, while surgery may be necessary if conservative treatments fail, it is essential to have a thorough discussion with your orthopedic surgeon about the potential benefits, risks, and alternative treatment options. The decision should be based on a comprehensive evaluation of your specific condition, lifestyle, and goals. Engaging in a robust rehabilitation program post-surgery will be vital for achieving the best possible outcome. Always ensure that you have a clear understanding of the procedure, recovery expectations, and any potential complications before making your decision.

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