Whats the best solution with an unstable patella? MRI says: Patellofemoral OA. The medial femorotibial joint is abnormal with chondral attenuation. Reactive oedema is present in the medial tibia with intraosseous cyst formation.The medial meniscus is truncated. Physio says not to op but to expect improvement in 6-8wk.
Dr. Dirk van Bavel
Dr. Dirk van Bavel
Orthopaedic surgeon
Hawthorn East
There are 2 separate problems here that need to be addressed. The first is an unstable patella. Initially this should be treated with physiotherapy to strengthen the quadriceps and VMO. If this fails you would consider surgery.The treatment for this depends on the pathology causing the instability. Surgical options include, ; MPFL reconstruction, tibial tubercle distillation/ medicalisation and trochleoplasty.
The treatment for Patellofemoral OA is analgesics and physiotherapy. If this fails you could consider a patellofemoral replacement.

Dr. Chien-Wen Liew
Dr. Chien-Wen Liew
Orthopaedic surgeon, General surgeon
Morphett Vale
We will have to know if you dislocated your patella before. It all depends also on how old you are, and what activities you want to do. If you are <40, the examples above are suitable. In addition to Vastus Medialis strengthening, you should focus on your core muscles, which studies have shown can help to realign the normal alignment of your knee cap. If this fails, sometimes surgery is required, but does require a CT scan to see what your bony alignment is like before determining what surgery you should receive. All the examples above are options. (Tibial Tubercle Distalisation or Medialisation; MPFL reconstruction; Trochlearplasty). It is a difficult condition to treat once you have bad arthritis. In Australia, patellofemoral joint replacements are relatively uncommon and require a surgeon who has experience in this.

The rest of your MRI show generalised arthritis, so I would opt to treat your knee with a total knee replacement, as a patellofemoral replacement is likely to fail in your case.

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