Always

1. Knee arthroscopy is always performed to assess the joint surface of the patella and trochlea. Any damage is treated accordingly.
2. MPFL reconstruction: A hamstring graft is used to replace the torn MPFL. The hamstring graft is attached to the femur with a so-called suture anchor and then fixed to the patella via small tunnels.

Sometimes

1. Tibial tubercle transfer is sometimes necessary: The insertion of the patellar tendon to the tibia is transferred to increase the stability on the patella.
2. Trochleoplasty is very seldom necessary: The shallow trochlea is deepened to increase the stability of the patella. This is only considered if the groove is very abnormal. This deformity is very rare in our South African population although it is more commonly described by French surgeons. I have only needed to perform one such operation to date in all the surgeries I have done for patella instability.

The smallest possible surgical procedure that will solve the problem will be performed. The French have described the approach to patella dislocation surgery as “a-la-carte surgery”. A bit too descriptive perhaps, but it very concisely describes our approach to this sometimes complex, but most often very simple problem.

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