The majority of patients don't go on to suffer chronic dislocations after an initial dislocation. Typically, physiotherapy is all that most initial dislocations require. However, a minority of patients do require Patellofemoral Stabilization for repeated dislocation.
Patients with severe instability may require the following:
1. Patella Tendon-Tibial Tubercle Transfer to either reduce the TT-TG distance or distalize the patella. or both.
2. Medial Patellofemoral Ligament Reconstruction
Patients with moderate instability, usually only require : Medial Patellofemoral Ligament Reconstruction.
The MPFL Reconstruction Involves transferring a hamstring tendon to the medial side of the replace the torn MPFL.
The Patella Tendon-Tibial Tubercle Anteromedialization involves raising a thin segment of bone with the patella tendon attached, and shifting it 10-12mm. The surgery is a combination of open and arthroscopic techniques, and most patients stay one to two nights in hospital. With the shift of the patella tendon on the bony block, most patients need a brace for a month till the bone heals to it's new position.
Risks of surgery are low, but include infection, blood clots, non union , scar numbness and screw irritation requiring later removal. The re-dislocation rate is about 5%.
Patients with a severely shallow trochlear groove may require the groove to be deepened in rare cases.