One of the exciting things about medicine is the way that emerging technologies can help to expand our toolbox of options and treatments for patients with knee pain.
We’ve seen that with robotic surgery for knee replacements. More recently, we’ve also seen some really encouraging developments in surgery for patellar dislocations – that is, for people who suffer from kneecaps that persistently pop out of joint.
What does a recurrent kneecap dislocation look like?
A kneecap dislocation can happen for a number of reasons. It might be caused by an accident – a thumping blow during football, say. Or it could be a ‘congenital’ situation – where your knee is just naturally predisposed to popping out of joint. When the joint does pop out, it can stretch or tear the ligaments that hold your kneecap in place. This could make you more likely to suffer a future dislocation. People with ‘hyperlaxity’ (unusually stretchy ligaments) are particularly susceptible.
What’s the current treatment for repeat dislocations?
One technique we use is an operation called MPFL Reconstruction. MPFL stands for medial patellofemoral ligament. It’s one of the ‘guy ropes’ in your knee, which anchors the inner (medial) part of your kneecap to your thighbone. If your MPFL is causing your kneecap to repeatedly pop out, this procedure aims to reconstruct it. The operation can be done by reinforcing the local tissue, or using other tendons such as hamstring tendons, but we use a synthetic polyester tape (this means we don’t have to use your own tissue, and the synthetic graft has been shown to be very strong and durable). The graft is then attached using a titanium staple. MPFL reconstruction is a common operation that has been very successful for many patients – especially young people. It restores stability, helps to prevent dislocations, and often enables people to get back to their normal level of activities.
How does the new technique work?
The new technique involves something called an interference screw fixation. A bit of a mouthful! But the idea is simple. Instead of a staple, the operation uses a headless medical screw to fix your new ligament in place. One advantage is that this gives excellent control over the tension in your knee; creating the right amount of tension in the new ligament is important, because it will allow you to fully and comfortably flex your leg: not too tight, not too loose. Another positive is that the screw sits ‘flush’ to your bone. Staples tend to be a little prominent in the joint, but a headless screw creates a flat surface and therefore should feel more natural.
Who is having the new operation?
We’ve now used the technique for a number of young patients with dislocation problems, and so far the results are really promising. When any new surgical technique or implant enters the market, it’s very important to monitor the outcomes carefully. So we’re keeping in regular touch with these patients to see how they’re getting on. Every few weeks they send us their ‘knee scores’ (a kind of self-survey that helps us to determine how their recovery is going). We also invite them to attend research clinics, where we can take a close look at their stability, their range of movements, and so on. We’re now hoping to include each case in a major multi-centre trial later this year.
MPFL Reconstruction has helped many patients say goodbye to persistent dislocations – and even get back to doing the sports they enjoyed before dislocations became a problem. In that sense, the screw fixation is really a new adaptation of an already-successful technique: it’s helping us to make a great operation even better.
Are you or a family member thinking about surgery for repeated dislocation? We would be happy to have a look at your knee and discuss the potential options. Please call Cheryl on 01962 826107, or fill out a quick form online, and we’ll book you for an appointment with Mr Bailey.