Patellar instability in children: Surgical and non-surgical treatment

 

What is patellar instability?

If your child has been diagnosed with patellar instability, that means their kneecap (patella) moves out of its normal position in the groove at the lower end of their thigh bone (femur). This can happen partially, known as subluxation, or completely, known as dislocation.

Children with this condition may experience pain, swelling, a sensation of their knee ‘giving way’, or repeated dislocations.

Non-surgical management of patellar instability

In most cases, non-surgical treatments are the initial approach your specialist will suggest, aiming to strengthen the muscles around their knee and improve stability.

Physiotherapy

Physiotherapy plays a crucial role in treating patellar instability in children. A tailored exercise programme focusing on strengthening their quadriceps, particularly the vastus medialis obliquus (VMO), can help stabilise the kneecap and prevent further dislocations. Exercises targeting hip and core strength can improve overall lower limb alignment too.

Bracing and taping

Knee braces or patellar taping techniques can provide your child’s kneecap with additional support, especially during physical activities. These methods can reduce discomfort and help guide the patella within its groove.

Choosing low-impact activities

Low-impact exercises such as swimming and cycling are often recommended for children with patellar instability. Your child may be advised to avoid high-impact activities such as running and jumping, to help prevent further knee instability.

Pain management

Your child can take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, to help manage the pain and inflammation associated with patellar instability. However, this kind of pain management should always be combined with strengthening and stabilisation exercises.

When would my child need surgery?

When non-surgical management is not enough, surgical intervention may be required. Surgery is usually considered if:

• Your child has frequent or recurrent patellar dislocations
• Non-surgical treatments have failed to improve stability
• There are underlying anatomical differences in their knees contributing to instability, such as a shallow trochlear groove, malalignment of the leg, or excessive lateral tracking of the patella

What are the surgical options for patellar instability?

Several surgical procedures can help stabilise your child’s kneecap and prevent future dislocations. Your child's specific condition and anatomical details will determine the best surgical route for them, and your specialist surgical team will be there to support and guide you.

Medial patellofemoral ligament (MPFL) reconstruction

This is one of the most performed procedures. The Medial Patellofemoral Ligament (MPFL) is a ligament that helps to stabilise the kneecap. If it becomes damaged due to repeated dislocations, reconstructing the ligament using a graft from another part of the body can be an effective way to restore stability.

Tibial tubercle osteotomy (TTO)

In cases where the patella is misaligned, repositioning the attachment point of the patellar tendon on the tibia (shinbone) can improve alignment and reduce the risk of dislocation. This procedure is generally considered in older adolescents with persistent instability and malalignment.

Trochleoplasty

For children with a shallow or abnormally shaped trochlear groove, a trochleoplasty procedure can deepen the groove to help keep the patella in place. This is a more complex procedure and is typically reserved for cases in which a child has significant anatomical abnormalities that can really benefit from correcting.

Recovery and rehabilitation

Rehabilitation is essential for recovery, whether you child has non-surgical or surgical treatment. Post-surgical physiotherapy is especially vital for restoring strength and mobility while reducing the risk of further instability.

Your child’s own recovery timeline will depend on the procedure that they’re having, but most children can return to normal activities within a few months, with full recovery taking up to a year.

Patellar instability in children can often be managed with non-surgical treatments. However, surgery may be necessary in cases of recurrent dislocations or underlying anatomical issues. Talking to a specialist can help us understand what’s causing the condition in your child, as a first step to getting the right treatment and physiotherapy support.