What is a Tibial Osteotomy?

During a tibial osteotomy, the surgeon removes a wedge shaped portion of the shin bone (tibia) to help compensate for a deformity in the knee joint. This deformity can cause the knee’s protective cartilage to wear on one side more than the other. This usually happens on the inside (medial side) of the knee.

Removing a piece of the bone under the knee changes the alignment of the shin and knee and redistributes the weight of the body on the knee. Changing the alignment can transfer the stress to a less worn area of the knee, helping to relieve pain.

what are the Benefits?

Tibial osteotomies treat a varus, or bowlegged, deformity at the knee. This deformity may result from past trauma or surgery, congenital deformity and/or the progression of a degenerative disease, such as osteoarthritis. Candidates for tibial osteotomies are in pain and may eventually require a knee replacement.

A tibial osteotomy could help delay a knee replacement for as many as 10 years. This makes the tibial osteotomy a viable option for younger patients who are not the best candidates for knee replacement since they will probably outlive the implant.

How is a Tibial Osteotomy Performed?

A tibial osteotomy usually involves cutting a wedge-shaped portion of bone from the tibia to correct the alignment of the knee. The surgeon will make a small incision on the front of the knee and/or another one on the side of the knee. The shinbone is exposed and a wedge shaped piece of the bone is removed just below the knee. The leg is moved in a way that allows the gap in the bone to be closed in a hinge-like manner. The edges of the cut bone are then stapled or held together with plates and screws. The osteotomy site should heal just like a fracture.

Is There a Risk of Complications?

All surgeries have a risk of complications. Some of the major complications with tibial osteotomy include damage to the nerves or arteries of the leg, blood clots or even problems with the cut bones healing together. As with any surgery, patients should be aware of signs of infection, bleeding or abnormal swelling in the first few weeks after surgery. Patients should inform their doctor if any of these symptoms occur.

Additionally some surgeons believe that the because of changes made to the bone during tibial osteotomy, it may make a total knee replacement more difficult down the road.

How Long is the Recovery?

Because the tibial osteotomy involves cutting the bone and having it mend back together, a significant postoperative course of therapy needs to be followed. Hospitalization can last from three to six days. Once out of the hospital, the knee will need to be immobilized with a cast or brace for at least six weeks. Crutches should be used during that time. Knee swelling can last for three to six months. Typically patients could miss three to six months of work, but that depends on the doctor’s recommendations and each individual case.

The road back to full weight bearing will differ with each patient’s progress and situation. Normally, weight-bearing activities can begin at six weeks after surgery and gradually increase up to 10 weeks post surgery. After 12 – 14 weeks the patient will be able to resume some higher impact activities. A physical therapist usually helps the patient through the rehabilitation process.

Anatomy

A bursa is a sack made of thin, slippery tissue that helps reduce friction wherever skin, muscles, or tendons slide over bone. The prepatellar bursa is located between the front of the kneecap (patella) and the overlying skin.

Causes

In some cases, a direct blow or a fall onto the knee can damage the bursa. This usually causes bleeding into the bursa sack, because the blood vessels in the tissues are damaged and torn. This can cause the bursa sack to swell up like a balloon. The walls of the bursa may thicken and become tender even after the body has absorbed the blood. This is known as prepatellar bursitis. People who work on their knees, such as carpet layers and plumbers, can repeatedly injure the bursa. Repeated injuries to the bursa can also cause prepatellar bursitis over a long period of time.

The prepatellar bursa can also become infected. This may occur without any warning, or it may be causes by a small injury and infection of the skin that spreads down into the bursa. In this case, instead of blood or inflammatory fluid in the bursa, it fills with pus. The area around the bursa becomes hot, red, and very tender.

Symptoms

Prepatellar bursitis causes pain and swelling in the area around the front of the kneecap. If the condition has been present for some time, small lumps may be felt underneath the skin over the kneecap. These lumps are usually the thickened folds of bursa tissue that have formed in response to chronic inflammation.

The bursa sack may swell and fill with fluid at times. This is usually associated with increased activity levels. People who are frequently on their knees, such as carpet layers, develop very thick bursa, almost like a kneepad in front of the knee.

If the bursa becomes infected, the front of the knee becomes swollen, tender and warm to the touch around the bursa. You may run a fever and feel chills. An abscess, or area of pus, may form on the front of the knee. If the infection is not treated quickly, the abscess may even begin to drain.

Diagnosis

If your doctor is uncertain whether or not the bursa is infected, a needle may be inserted into the bursa and the fluid removed. This fluid will be sent to a lab for tests to determine whether infection is present. If infection is found, antibiotics are usually given.

Treatment

Non-Surgical Treatment

Prepatellar bursitis caused by an injury will normally go away on its own. The body will absorb the blood in the bursa over several weeks. If swelling in the bursa is causing a slow recovery, a needle may be inserted to drain the blood and speed up the process. There is a slight risk of infection in putting a needle into the bursa.

Chronic prepatellar bursitis can be a major problem. The swelling and tenderness causes pain and difficulty when kneeling. Treatment usually begins by trying to control the inflammation. This may include a short period of rest or possibly a brace to immobilize the knee. Medications such as ibuprofen and aspirin may be suggested by your doctor to control inflammation and swelling. A kneepad may also be helpful to ease the pain.

If an infection is found, the bursa will need to be drained several times over the first few days. You will be placed on antibiotics for several days. If the infection is slow to heal, the bursa may have to be drained surgically.

Your doctor may also prescribe rehabilitation. Your physical therapist may suggest the use of heat, ice, and ultrasound to help calm pain and swelling. The therapist may also suggest specialized stretching and strengthening exercises used in combination with a knee brace, taping of the patella, or shoe inserts. These exercises and aids are used to improve muscle balance and joint alignment of the hip and lower limb, easing pressure and problems in the bursa.

Surgery

Surgery is sometimes necessary to remove a thickened bursa. Surgical removal is usually done because the swollen bursa is restricting your activity. A small incision is made to remove the bursa.

You may need to stay off your feet for several days to allow the wound to begin to heal and to prevent bleeding into the area where the bursa was removed.

The body will form another bursa as a response to the movement of the patella against the skin during the healing phase. If the healing process goes well, the newly formed bursa will not be thick and painful.

Rehabilitation

Chronic prepatellar bursitis will usually improve over a period of time. The fluid-filled sack is not necessarily a problem, and if it does not cause pain, it is not always a cause for alarm or treatment. The sack of fluid may come and go with variation in activity.

If surgery is required, you and your doctor will come up with a plan for your rehabilitation. You will have a period of rest, which may involve using crutches. You will also need to start a careful and gradual exercise program. Patients often work with a physical therapist to direct the exercises for their rehabilitation program.

Introduction

A popliteal cyst, also called a Baker’s cyst, is a soft, often painless cyst on the back of the knee. A cyst is usually nothing more than a bag of fluid. These cysts occur most often when the knee is damaged due to arthritis, gout, injury, or from inflammation of the joint lining. Treatment of the cyst is most successful when the underlying cause of the cyst is also treated. Otherwise, the cyst can recur.

In rare instances, the cyst can cause pressure on blood vessels, causing swelling or other problems in the leg. A ruptured popliteal cyst can be very painful. The symptoms caused by a popliteal cyst can mimic more serious problems; therefore, careful clinical evaluation is important.

The purpose of this information is to help you understand popliteal cysts:

• the nature of the disorder and the normal anatomy of the knee
• the signs and symptoms of the disorder
• the treatments available to you now and later
• what you can expect from those treatments
• what you can expect long-term if you have this disorder

In order to understand what is happening with your knee joint, you need to understand the basics about the normal anatomy of your knee. This includes becoming familiar with the various parts of the knee. The more you know about your knee, the better you’ll be able to communicate with your doctor and healthcare team.

Anatomy

A joint is formed where two or more bones meet. The knee is a hinge type joint and is formed where the thighbone (femur) meets the shinbone (tibia). The thighbone is rounded on the end and rocks back and forth on the flat surface formed on the end of the shinbone. A smooth cushion of articular cartilage covers the surface ends of both of these weight-bearing bones. The articular cartilages are kept slippery by joint fluid made by the synovial membrane (joint lining). Since the cartilage is smooth and slippery, the bones move against each other easily and without pain.

In addition to bones, the knee joint also consists of “soft tissues” including ligaments, tendons, muscles and blood vessels. These soft tissues work with the bones in the following ways to provide the mechanics of the knee:

• Bones are attached (connected) to bones by ligaments
• Muscles attach bones to tendons
• Electrical impulses are sent by nerves to the muscles, which makes them contract and relax causing the joint to bend and straighten.
• Blood vessels carry needed oxygen, nutrients and fuel to the muscles to allow them to work normally and heal when injured.

Causes

A popliteal cyst forms when the joint lining produces too much joint fluid. The extra fluid leaks or pushes through the joint lining and forms a cyst. The cyst often “sticks out” on the back of the knee between two muscles.

If the cyst ruptures, it can cause pain and swelling of the calf. A ruptured popliteal cyst has symptoms similar to a much more serious problem called thrombophlebitis. Therefore, it is important to determine right away the cause of the pain and swelling in the calf.

Symptoms

The symptoms caused by a popliteal cyst are usually mild. You may have aching or tenderness with exercise or your knee may buckle. Sometimes, there is pain from the underlying cause of the cyst, such as arthritis, an injury, or a mechanical problem with the knee.

Along with these symptoms, you may also see or feel a bulge on the back of your knee. Anything that causes swelling of the knee and more fluid in the knee joint can make the cyst larger. It is common for a popliteal cyst to swell and shrink over time.

Sometimes a cyst will suddenly rupture, or burst underneath the skin, causing a lot of pain and swelling in the calf. The fluid inside the cyst simply leaks into the calf and is absorbed by the body.

In this case, you will no longer be able to see or feel the cyst. However, the cyst will probably return in a short time.

Diagnosis

Your doctor will need to know the history of your problem, such as how long you have had the problem, whether it’s getting worse, and whether it has kept you from doing any daily activities, like walking, working or participating in other physical activities. Additionally, he’ll want to know what makes it better or worse and if you have any pain.

Your doctor will examine your knee and leg. He will ask you to bend and straighten your knee to see if he can feel or see the cyst. Most often, a physical exam is all that is needed to diagnose a popliteal cyst. Unless the cyst has ruptured, further testing is usually not needed.

If the cyst has ruptured, additional tests will be needed. Because x-rays show mostly bones, they will not show the cyst since it is a soft tissue. A cyst can be seen with a sonogram or arthroscopy.

Treatment

There are two types of treatment for popliteal cysts: surgical and non-surgical. Whether or not the cyst has ruptured, how painful the cyst has become, or how much it interferes with the normal use of your knee will determine which is the best course of treatment for you. In adults, the treatment is most often non-surgical. If surgery is needed, it is usually done on an outpatient basis. Unless there is a lot of discomfort from the cyst, surgery is rarely indicated.

Non-Surgical

Drawing the fluid out with a needle and syringe can reduce the size of the cyst. Then, cortisone can be injected into the affected area to reduce inflammation.

Non-surgical treatment also includes rest and keeping your leg propped up for several days. If non-surgical treatment fails, then complete removal of the cyst may be needed.

Many people, once they are reassured that the cyst is not dangerous, simply ignore the problem unless it becomes very painful.

Surgical Treatment

The goal of surgery is to remove the whole cyst and repair the hole in the joint lining where the cyst pushed through.

Surgery can be slow and take over an hour to complete. Surgery is usually done under a general anesthetic, where you are completely asleep during surgery. A spinal anesthesia may also be used. A “spinal” works by numbing the lower half of your body. With spinal anesthesia, you may be awake during the surgery, but you won’t be able to see the surgery.

Once the anesthesia has taken effect, your surgeon will make sure the skin of the knee is free of infection by cleaning the skin with a germ-killing solution. An incision will be made in the skin over the cyst. The cyst is located and then separated from the surrounding tissues. The area of the joint capsule where the cyst originated is identified. A synthetic patch may be sewn in place to cover the hole in the joint capsule left by the removal of the cyst. Special care is taken not to damage nearby nerves and blood vessels.

Your knee will be bandaged with a well-padded dressing and a splint for support. Your surgeon will want to check your knee within five to seven days. Stitches will be removed after 10 to 14 days. Most of your stitches will be absorbed into your body. You may have some discomfort after surgery, but you will be given pain medicine to control the discomfort.

You should keep your knee propped up for several days to limit swelling and throbbing. Keep it propped up on a stack of pillows when sleeping or sitting up. Take all medicines exactly as prescribed by your physician, and be sure to keep all follow-up appointments.

Complications

You should expect complete healing without complications in about four weeks. The most common possible complication after surgery is infection of the incision. If infection occurs, your surgeon may prescribe antibiotics to fight infection, or surgery may be needed to drain the infection. After surgery, keep 24-hour phone numbers handy. Call your surgeon’s office if you feel your knee is not healing as it should. Check your incision as instructed by your doctor. If you think you have a fever, take your temperature. If signs of infection or other complications are present, call your surgeon right away.

These are warning signs of infection or other complications:

• pain in your knee that is not relieved by your medicine
• smelly discharge coming from your incision
• red, hot swollen incision
• chills or fever over 100.4 degrees F
• you notice bright red blood coming from your incision
• side effects from your medicine

Since popliteal cysts form very near to the major nerves and blood vessels of the leg, one possible complication of surgery is that one of these nerves or vessels could be injured during the procedure. Injury to the nerves can cause numbness or weakness in the foot and lower leg. Injury to the blood vessels may require surgery to repair them. A further complication that is uncommon but possible is that another cyst can develop.

Rehabilitation

After your surgery, you can resume daily activities and work as soon as you are able. Your doctor may want you to use crutches or a cane for a time. Avoid vigorous exercise for six weeks after surgery. You should be able to resume driving two weeks after surgery. A short course of physical therapy may be indicated to help you regain the strength in your leg.

Summary

While a popliteal cyst is not a life-threatening problem, a ruptured cyst can mimic one and can be cause for concern until a diagnosis is made. It is important to know that these cysts are always limited to the knee. The cysts are not cancerous and will not become cancerous.

Removal of the entire cyst, if necessary, will usually give a very good result. The cure is often permanent, but preventing further cysts depends a great deal on the success of treating the underlying cause.

Introduction

Plica syndrome occurs when an otherwise normal structure in the knee becomes a source of knee pain due to injury or overuse.

Plica is a term used to describe a fold in the lining of the knee joint. Imagine the inner lining of the knee joint as nothing more than a sleeve of tissue. This sleeve of tissue is made up of synovial tissue, a thin, slippery material that lines all joints. The synovial sleeve of tissue has folds of material that allow movement of the bones of the joint without restriction.

Four plica synovial folds are found in the knee, but only one seems to cause trouble. This structure is called the medial plica. The medial plica attaches to the lower end of the kneecap and runs sideways to attach to the lower end of the thighbone at the side of the knee joint closest to the other knee.

Causes

A plica causes problems when it is irritated. Over time the plica can be irritated by certain exercises, repetitive motions, or kneeling. Activities that repeatedly bend and straighten the knee, such as running, biking, or use of a stair-climbing machine, can irritate the medial plica and cause plica syndrome.

If the knee is injured, the plica and the synovial tissue around the plica can swell and become painful. The initial injury may lead to scarring and thickening of the plica tissue later. The thickened, scarred plica fold may be more likely to cause problems later.

Symptoms

The primary symptom of plica syndrome is pain. There may also be a snapping sensation along the inside of the knee as the knee is bent, due to the rubbing of the thickened plica over the edge of the thighbone. If the plica has become severely irritated, the knee may become swollen. Pain from plica syndrome usually occurs when the knee is straightened from a flexed or bent position to a straight position.

Diagnosis

History and Physical Exam

Diagnosis begins with a history and physical exam. The examination will try to determine where the pain is located and whether or not the band of tissue can be felt. X-rays will not show the plica. X-rays are mainly useful to determine if other conditions are present if there is not a clear-cut diagnosis.

Radiological Tests

If there is uncertainty in the diagnosis or if other injuries are suspected, an MRI may be suggested. The MRI (magnetic resonance imaging) uses magnetic waves to show the soft tissues of the body. This test does not require any needles, X-rays or special dye and is painless. A CAT scan may also be used to see whether the plica has become thickened. Most cases of plica syndrome will not require special tests such as the MRI or CAT scan. A plica band can not always be seen on a MRI or CAT scan.

Diagnostic Tests

If the history and physical examination strongly suggest that a plica syndrome is present, arthroscopy may be suggested to confirm the diagnosis and treat the problem at the same time. Arthroscopy is an operation that involves inserting a small fiber-optic TV camera into the knee joint, allowing the orthopedic surgeon to look at the structures inside the knee to determine whether the plica is inflamed.

Treatment

Most people with plica syndrome get better without surgery. The primary treatment goal is to reduce inflammation. This may require limiting activities like running, biking, or using the stair-climbing machine.

Conservative Treatment

Most people with plica syndrome get better without surgery. The primary treatment goal is to reduce inflammation. This may require limiting activities like running, biking, or using the stair-climbing machine.

Surgery

If conservative treatments fail, surgery may be suggested. Usually, an arthroscope is inserted into the knee joint through one-quarter inch incisions. Once the plica is located, small instruments are inserted through another one-quarter inch incision to cut away the plica tissue and remove the structure. The area where the plica is removed heals back with scar tissue.

Rehabilitation

Following surgery, you will be referred to a physical therapist. Your first few rehabilitation sessions are designed to ease pain and swelling and help you begin gentle knee motion and thigh tightening exercises. Patients rarely need to use crutches after this kind of surgery.

As symptoms of swelling and pain are controlled, the focus of exercise is to get the quadriceps muscle moving again. Patients usually start with isometric exercises to tighten the front thigh muscle, advancing to straight-leg lifts. Muscle stimulation may be needed at first if the quadriceps muscle is sluggish. This technique uses electrical current passed though electrodes placed on the skin over the muscle.

As the program evolves, more challenging exercises are chosen. Patients do exercises that mimic familiar activities like squatting down, lunging forward, and going up or down steps. These exercises are designed to help keep pressure off the kneecap while getting a challenging workout for the leg muscles. Your therapist will work with you to make sure you are not having extra pain in your knee during the exercises. You may be shown stretches for the soft tissues along the edge of the kneecap as well as muscle stretches for the hamstrings, quadriceps, and calf muscles.

The therapist’s goal is to help patients keep their pain under control, make sure they aren’t putting too much weight on the injury, and improve quadriceps muscle strength and knee range of motion. When patients are well underway, their regular visits to the therapist’s office will end. The therapist will continue to be a resource, but patients will be in charge of doing their exercises as part of an ongoing home program.

Anatomy

The patella, or kneecap, is the moveable bone on the front of the knee. The patella is wrapped inside a tendon connecting the large muscles on the front of the thigh and the quadriceps muscles, to the lower leg bone. This tendon is called the quadriceps tendon above the patella and the patellar tendon below the patella.

The quadriceps mechanism, made up of the patella and tendon, allows you to straighten out the knee. The patella acts like a fulcrum to increase the force of the quadriceps muscle. The underside of the patella is covered with articular cartilage, the smooth, slippery covering found on joint surfaces. This covering helps the patella glide in a groove made by the thighbone, or femur called the patellofemoral grove. Together the patella and the groove in the femur are called the patellofemoral mechanism.

Causes

Problems commonly develop when the patella suffers wear and tear. The underlying cartilage begins to degenerate. Degeneration may develop as part of the aging process. The patellofemoral joint is usually affected as part of osteoarthritis of the knee.

One of the more common causes of knee pain is a problem with the way the patella moves through the patellofemoral groove. If part of this muscle is weak a muscle imbalance can occur. When this happens, the pull of the quadriceps muscle may cause the patella to shift to the outside. This, in turn, causes more pressure on one side of the articular cartilage than the other. In time, this pressure can damage the articular cartilage.

Another type of imbalance may exist due to differences in how the bones of the knee are shaped. Some people are born with a greater than normal angle where the femur and the tibia (shinbone) come together at the knee joint. Women tend to have a greater angle than men. The patella sits at the center of this angle within the femoral groove. When the quadriceps muscle contracts, the angle in the knee straightens, pushing the patella to the outside of the knee. In cases where this angle is increased, the patella tends to shift outward with greater pressure. As the patella slides through the femoral groove, this places more pressure on one side than the other, leading to damage to the underlying articular cartilage.

In some cases one side of the patellofemoral groove may be smaller than normal. This may cause the patella to actually slip out of the groove, causing a patellar dislocation. This is not only painful, but can cause degeneration of the patellofemoral joint if dislocation repeatedly happens.

Symptoms

If you have patellofemoral problems, you may feel like the patella is slipping. This is thought to be a reflex response to pain and not because there is any instability in the knee.

Sometimes you may have pain around the front part of the knee or along the edges of the kneecap. These symptoms may be related to the way the patella lines up in the femoral groove. Symptoms of patellar pain, however, can happen even when the patella appears to be lined up properly.

In other cases you may notice a dull pain in the knee that isn’t centered in any one spot. Typically, if you have patellofemoral problems you may experience pain when walking down stairs or hills. Keeping the knee bent for long periods, such as sitting in a car or movie theater, may also cause pain. The knee may also grind, or you may hear a crunching sound when you squat or go up and down stairs.

If there is a considerable amount of wear and tear, popping or clicking may be felt when the knee is bent. This happens when the uneven surfaces of the underside of the patella and the femoral groove rub against one another. The knee may swell with heavy use and become stiff and tight. This is usually due to fluid accumulating inside the knee joint, sometimes called “water on the knee.”

Diagnosis

Diagnosis begins with a complete history of your knee problem followed by an examination of the knee and the patella. X-rays may be ordered on the initial visit to your doctor. An X-ray can help determine if the patella is properly aligned in the patellofemoral groove. The X-ray may show arthritis between the patella and thighbone, especially when the problems have been present for a considerable amount of time.

Diagnosing problems with the patella can be confusing, so other tests, such as magnetic resonance imaging (MRI), may be suggested. The MRI machine uses magnetic waves rather than X-rays to show the soft tissues of the body.

This machine creates pictures that look like slices of the knee. Usually, this test is done to look for injuries, such as tears in the menisci or ligaments of the knee. Recent advances in the quality of MRI scans have enabled doctors to see the articular cartilage on the scan and determine if it is damaged. This test does not require any needles or special dye and is painless.

In some cases, arthroscopy may be used. Arthroscopy is an operation that involves placing a tube with a small fiber-optic TV camera into the knee joint, allowing the orthopedic surgeon to look at the structures inside the joint directly. The arthroscope allows your doctor to see the condition of the articular cartilage on the back of your patella. The vast majority of patellofemoral problems are diagnosed without resorting to surgery, and arthroscopy is usually reserved to treat the problems identified by other means.

Treatment

Treatment begins by decreasing the inflammation in the knee. Rest and anti-inflammatory medications, such as aspirin or ibuprofen, may be suggested by your physician, especially when the problem is due to overuse.

Physical therapy can help in the early stages by decreasing pain and inflammation. Your physical therapist may suggest the use of ice massage and ultrasound to limit pain and swelling. You may also be directed to use a brace or tape the patella to help reduce pain. As the pain and inflammation become controlled, your physical therapist can provide several exercise options to help correct problems with flexibility, strength, foot or knee alignment, and muscle balance in the knee.

Surgery

If these measures fail to improve your condition, surgery may be suggested. Arthroscopy is sometimes useful in the treatment of patellofemoral problems of the knee. Looking directly at the articular cartilage surfaces of the patella and the patellofemoral groove is the most accurate way of determining how much wear and tear there is in these areas. Your physician can also watch as the patella moves through the groove, and may be able to decide whether or not the patella is moving normally.

If there are areas of articular cartilage damage behind the patella that are creating a rough surface, special tools can be used by the surgeon to smooth the surface and reduce your pain. This procedure is sometimes referred to as “shaving” the patella. In more advanced cases of patellar arthritis, doctors may operate to repair or restore the damaged cartilage.

The type of surgery needed for articular cartilage is based on the size, type, and location of the damage. Along with surgical treatment to fix the cartilage, other procedures may also be done to help align the patella so less pressure is placed on the healing cartilage.

If your patella problems appear to be caused by a misalignment problem, a procedure called a lateral release may be suggested. This procedure is done to allow the patella to shift back to a normal position and relieve pressure on the articular cartilage. In this operation, the tight ligaments on the outside (lateral side) of the patella are cut, or released, to allow the patella to slide more towards the center of the femoral groove. These ligaments eventually heal with scar tissue filling the gap created by surgery.

For problems of repeated patellar dislocations or severe patellar malalignment, the doctor may also need to realign the quadriceps mechanism. In addition to the lateral release, the tendons on the inside edge of the knee (the medial side) may have to be tightened.

If the malalignment is severe, the bony attachment of the patellar tendon may also have to be shifted to a new spot on the tibia bone. Doctors can change the way the tendon pulls the patella through the groove in the femur by surgically removing a section of bone where the patellar tendon attaches on the tibia. This section of bone is then reattached on the tibia closer to the other knee.

Usually, the bone is reattached onto the tibia using screws. This procedure shifts the patella to the inside the knee. Once the surgery heals, the patella should track better within the center of the patellar groove, spreading the pressure equally on the articular cartilage.

Rehabilitation

Many doctors will have their patients participate in formal physical therapy after knee surgery for patellofemoral problems. Patients undergoing a patellar shaving usually begin rehabilitation right away. More involved surgeries for patellar realignment or restorative procedures for the articular cartilage require a delay before going to therapy.

The first few physical therapy treatments are designed to help control the pain and swelling from the surgery. The physical therapist will choose exercises to help improve knee motion and to get the quadriceps muscles toned and active again. Muscle stimulation, using electrodes over the quadriceps muscle, may be needed at first to get the muscle moving again.

As the program evolves, more challenging exercises are chosen to safely advance the knee’s strength and function. The key is to get the soft tissues in balance through safe stretching and gradual strengthening.

The physical therapist’s goal is to help you keep your pain under control, ensure you place only a safe amount of weight on the healing knee, and improve your strength and range of motion. When you are well underway, regular visits to the therapist’s office will end. The therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.