Pain Syndrome > Treatments
Surgical Kneecap Realignment
Preparing for Surgery
The decisions you make and the
actions you take before your surgery can be every bit
as important as the procedure itself in ensuring a healthy
recovery. Make sure you have received any equipment
you will need when you get home from the hospital. This
may include a knee brace, crutches, ice packs or coolers,
or a continuous passive motion (CPM) machine. You should
receive prescriptions for any of these from your doctor
when your surgery is scheduled.
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
reduce the risk of infection, try to refrain from smoking
for at least a week prior to surgery.
possible, practice walking with your crutches in case
you need to use them after surgery.
insurance companies require a second opinion before
agreeing to reimburse a patient for a surgical procedure.
Getting a second opinion from a surgeon who is as qualified
as the surgeon who gave the initial diagnosis is advisable
in any case.
sure the orthopedist performing the surgery is board-certified,
which can be determined by calling the American Board
of Orthopaedic Surgery at 919-929-7103.
to ask the doctor
to take to the hospital
At most medical centers, you will
go to "patient admissions" to check in for
your surgical kneecap realignment. If your surgery is
going to be inpatient, there may be a separate department,
so be sure to ask your doctor. After you have checked
in to the hospital or clinic, you will go to a holding
area where the final preparations are made. The paperwork
is completed and your knee area may be shaved (this
is not always necessary). You will wear a hospital gown
and remove all of your jewelry. You will meet the anesthesiologist
or nurse anesthetist (a nurse who has done graduate
training to provide anesthesia under the supervision
of an anesthesiologist). Then, you will walk or ride
on a stretcher to the operating room. Most patients
are not sedated until they go into the operating room.
Here are some important steps to remember for the day
of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
the anesthetic and pain medications may make you drowsy,
arrange for someone to drive you home when you are released.
a loose pair of pants or other clothing that will fit
comfortably over your knee bandage when you leave the
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
to take to the hospital
Surgical kneecap realignment usually
takes one to one-and-a-half hours. After anesthesia
is administered, which may be regional or general, the
surgical team sterilizes your leg with antibacterial
solution. Then, the instruments are set up.
four-to five-inch incision is usually made over the
bump at the top of your shin (tibial tubercle).
saw is used to free up the tubercle.
kneecap is then moved into proper position inside the
track along the end of the thighbone. It usually requires
the kneecap to be slightly elevated.
tubercle is secured in its new location with two screws.
The new attachments generally heal as strong as before
are sewn up and the patient is taken to the recovery
After surgical kneecap realignment, you usually stay
in the recovery room for at least two hours while the
anesthetic wears off. You will be given adequate pain
medicine, either orally or through an IV (intravenous)
line, as well as instructions for what to do over the
next couple of days. In addition, you will be given
an appointment to return and a prescription for pain
medicine. Your knee will be bandaged and may have ice
on it. You may have significant pain early on and you
should take the pain medicine as directed. Remember
that it is easier to keep pain suppressed than it is
to treat pain once it becomes present. When you feel
the pain coming on take another pill, as long as it
is within the time limit on the bottle. Surgical kneecap
realignment is usually an outpatient procedure. However,
if your surgeon had to do something more extensive,
then you may have to stay overnight. You should try
to move your feet while you are in the recovery room
to improve circulation. Your temperature, blood pressure,
and heartbeat will be monitored by a nurse, who, with
the assistance of the doctor, will determine when you
are ready to leave the hospital or, if necessary, be
admitted for an overnight stay. It is likely that you
will be able to bear some weight on your leg, but your
surgeon may suggest that you use crutches for up to
one month. As soon as you are fully awakened, you are
usually allowed to go home. You will probably be unable
to drive a car so be sure to have arranged a ride home.
Here is what you can expect after
surgical kneecap realignment to treat patellofemoral
will likely feel pain or discomfort for the first few
days, and you will be given a combination of pain medications
as needed. A prescription-strength painkiller is usually
prescribed and should be taken as directed on the bottle.
Taking one every four to six hours as directed is a
good idea in the first 24 hours to suppress pain.
may be drainage on the bandage since fluid may have
accumulated during the surgery. Expect some blood to
show through the bandage during the first 24 to 48 hours.
should usually continue with the ice for at least 24
hours and remove the dressing within the first 48 hours.
Icing your knee for 20 or 30 minutes a few times a day
during the first two days after surgical kneecap realignment
will help reduce pain. Ice therapy is most effective
in the first 24 to 48 hours.
much as possible, you should keep your knee elevated
above heart level to reduce swelling and pain. It often
helps to sleep with pillows under your ankle.
until you can stand comfortably for 10 or 15 minutes
at a time before you take a shower. Once you can, put
your leg in a plastic bag and tie the top around your
leg above the knee bandage to keep the bandage dry.
Ask your physician about the best place to buy plastic
shower bags in your area.
or a cane may be needed for about a month following
surgical kneecap realignment, but you can usually put
a little weight on your knee and begin walking. The
pain typically feels like you bumped into a table.
soon as possible after surgery, you should begin doing
physical therapy as directed by your surgeon.
two or three days after surgery, you may experience
night sweats and a fever of up to 101. Your physician
may suggest acetaminophen, coughing, and deep breathing
to get over this. This is common and should not alarm
may return to work the next day after surgery, depending
on the severity of your pain.
to call the doctor after surgery
Your physician may prescribe visits
to a physical therapist to begin supervised strengthening
exercises as soon as possible after surgical kneecap
realignment. You can begin therapy immediately after
surgery in most cases. Patients should do stretching
and strengthening exercises for a minimum of four days
a week. The workouts should focus on the knee for at
least thirty minutes and be combined with a cardiovascular
workout that does not include activities, such as running,
that place stress on your knee. Despite your dedication
to the rehab program, you may not feel any improvement
for up to six weeks or longer and your kneecap pain
may recur. Though everyone's rehab program is slightly
different, physical therapy after surgical kneecap realignment
follows a general pattern. Most people can begin stretching
the muscles and tendons around the kneecap within a
week. Though your knee may be weak, it is generally
strong enough to handle mild stretching and slow movements.
Working to restore early range of motion may help reduce
swelling and stiffness, and increase your healing time.
Rehab progresses into strengthening exercises that focus
on the quadriceps and hamstrings – the main stabilizing
muscles for your knee. Physicians suggest you gradually
increase the amount of weight as your leg muscles get
stronger. Strengthening exercises require dedication
because results often take weeks and pain may recur.
Once the muscles of your injured leg are about as strong
as the uninjured leg, the focus of rehab turns to increasing
your coordination. After about six weeks of rehab, physical
therapy can become activity oriented as you regain the
ability to perform complicated movements, using stationary
bikes, elliptical machines, and cross-country skiing
machines. Physicians usually suggest that you continue
strength training even after your kneecap has been rehabilitated.
Have your physician periodically check your kneecap
for strength and proper tracking.
strengthening exercises: Kneecap (patella) injuries
To decrease the risk of patellofemoral
pain returning after surgical kneecap realignment, physicians
generally recommend that you make the stretching and
strengthening exercises you learned in rehab part of
your everyday routine. Proper rehab will help your new
kneecap attachments heal in a normal position so your
kneecap moves smoothly in its track. To prevent rupturing
your new kneecap attachments while they heal, avoid
bending your knee more than 90 degrees. Try to be patient
in rehab and do not rush to return to activities. Many
of the exercises and activities that are popular for
fitness put stress on your knees. To prevent patellofemoral
pain it is important to learn knee-sparing exercise
techniques by dividing your activities into three components:
living – the average person takes between 12,000
and 15,000 steps a day, exerting a force between two
and five times your body weight on your knees. After
a knee injury, take it easy on your knees during the
day whenever possible to save them for activities and
exercise. Avoid stairs when there is an elevator, take
the shortest path when walking, and consider wearing
athletic shoes designed to absorb shock rather than
strengthening and conditioning – activities themselves
are not a substitute for conditioning. Your need for
special conditioning to prepare for activities increases
with age. The best strengthening programs are low-impact
and non-weight-bearing, like stationary bikes and certain
weightlifting programs, so that the knees do not have
to absorb shock.
– sports that require twisting and quick direction
changes put great strain on your knee. Any climbing
or jumping activity where the knee is bent beyond 90
degrees puts undue pressure on the cartilage surfaces
under the kneecap. To prevent injury, stick to light,
non-impact activities for your recreation after surgical
kneecap realignment. If you decide to return to sports
like football and basketball, a physician should carefully
examine your kneecap and test it for proper alignment.
After surgical kneecap realignment, if you plan on
participating in sports, remember to take it easy during
daily activities and to keep your kneecap tracking properly
with stretching and strengthening exercises. Your physician
may prescribe a brace that should be worn during any
recreation to help keep your kneecap in track. A small
amount of pain is normal during physical activity, but
if you feel so much pain in your knee to warrant taking
a painkiller before an activity, you should consider
cutting back or stopping.
| Treatment Introduction
A surgical kneecap realignment (tibial
tubercle osteotomy and elevation) is performed when
your kneecap has moved out of position and all other
efforts to put it back into the natural kneecap track
along the thighbone have failed. This open surgery has
the longest recovery time of all patellofemoral pain