What is Patella Stabilisation?

The patella, or kneecap, plays a crucial role in normal knee movement. In some people, the patella can become unstable and may slide out of place or dislocate—often during sports or twisting movements. This can lead to pain, a feeling of giving way, and long-term damage to the knee joint if left untreated.

Patella instability may be caused by anatomical factors such as a shallow groove in the femur (trochlear dysplasia), loose ligaments, a high-riding patella (patella alta), or abnormal alignment of the kneecap in relation to the thigh and shin bones.

When physiotherapy and non-surgical treatment do not resolve symptoms or when instability becomes recurrent, surgical stabilisation may be recommended. Two commonly used procedures are MPFL reconstruction and tibial tubercle osteotomy (TTO).

  • MPFL Reconstruction

    The medial patellofemoral ligament (MPFL) is a soft tissue structure that helps hold the kneecap in place, particularly as the knee straightens. If the patella has dislocated, the MPFL is often stretched or torn, leading to ongoing instability.MPFL reconstruction is a procedure that restores this important ligament. A small tendon graft—often taken from the patient's hamstring—is used to create a new ligament, which is fixed between the inner side of the kneecap and the thigh bone (femur). This helps guide the patella into the correct position as the knee moves.MPFL reconstruction is typically performed using keyhole and small open incisions. It provides strong and reliable stabilisation, particularly in patients whose instability is due to soft tissue laxity rather than bone alignment issues.

  • Tibial Tubercle Osteotomy (TTO)

    In some patients, the root of the instability lies in the alignment of the bones. The tibial tubercle is the bony point on the shinbone (tibia) where the patellar tendon attaches. If this attachment is positioned too far laterally (toward the outer side of the leg) or if the patella rides too high, it can pull the kneecap out of its normal tracking pathway.Tibial tubercle osteotomy involves surgically repositioning this bony attachment. The surgeon carefully cuts the tibial tubercle and shifts it inward (medialisation) and/or downward (distalisation) to realign the patella. The bone is then fixed in its new position with screws, allowing for improved tracking and stability.TTO is often combined with MPFL reconstruction in cases where both soft tissue and bony factors contribute to instability.

  • Recovery and Rehabilitation

    After surgery, you will typically wear a knee brace for a few weeks to protect the repair. Crutches are used initially, especially after a TTO, to reduce weight-bearing until the bone has healed. Physiotherapy is an essential part of recovery and focuses on restoring strength, flexibility, and control of the knee.


    Return to sport is gradual and may take several months, depending on the complexity of the surgery and your individual progress. Most patients are able to return to normal daily activities well before full sports clearance.
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