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Kneecap Dislocation (MPFL Surgery)

Kneecap Dislocation (MPFL Surgery)

Recurrent kneecap dislocation assessed properly — ligament, bony anatomy and alignment. MPFL reconstruction by Dr. Sunku when rehabilitation is not enough.

A kneecap that slips out of place — patellar dislocation or subluxation — is one of the most under-treated knee problems we see. The first dislocation is usually blamed on bad luck. The second one is a pattern, and by then the medial patellofemoral ligament (MPFL), the main soft-tissue restraint holding the kneecap in its groove, has almost always been stretched or torn.

Dr. Nitin N Sunku assesses recurrent kneecap instability the way it needs to be assessed: not just the torn ligament, but the shape of the trochlear groove, the height and tracking of the patella, limb alignment and rotational profile. That assessment decides whether you need rehabilitation, an MPFL reconstruction, or a bony procedure alongside it — because reconstructing a ligament on top of an uncorrected bony problem is how repeat dislocations happen.

Conditions We Treat

First-Time Patellar Dislocation

Usually a twisting movement on a planted foot, or a direct blow. The kneecap often relocates on its own when the knee straightens, so patients arrive describing a knee that “went out and came back”. Swelling is immediate. An MRI matters here: it shows the MPFL tear and, importantly, whether a fragment of cartilage or bone has been sheared off.

Recurrent Patellar Instability

Repeated dislocations, or a knee that gives way and feels like the kneecap is sliding sideways on stairs, squats or turns. Each episode risks further cartilage damage on the back of the patella, which is the reason we do not simply keep bracing and waiting.

Patellar Maltracking Without Full Dislocation

Pain at the front of the knee, a sense of the kneecap riding to the outside, and apprehension when the knee is bent under load. Often mislabelled as ordinary “runner’s knee” for years before the tracking problem is identified.

Underlying Anatomical Risk Factors

Trochlear dysplasia (a shallow groove), patella alta (a high-riding kneecap), an increased TT-TG distance, generalised ligament laxity, and rotational malalignment. These are what turn one dislocation into a lifelong pattern, and they change the operation we recommend.

If your kneecap has dislocated more than once, or the first episode left you unable to trust the knee, that is the point to be examined properly rather than to buy another brace.

Treatment Approach / Procedures Offered

Non-Surgical Management

A genuine first-time dislocation with no loose fragment is usually treated without surgery. That means a short period of protected weight-bearing, then a structured rehabilitation programme focused on vastus medialis and gluteal strength, hip control, and correcting the movement patterns that let the knee collapse inward. Bracing has a role early on. The honest limitation: rehabilitation strengthens the muscles around an already-damaged ligament — it does not repair the MPFL, so a knee with strong anatomical risk factors may still redislocate.

MPFL Reconstruction

For recurrent instability, the MPFL is reconstructed rather than repaired, most often using a hamstring graft (gracilis) fixed to the patella and to the femur at the anatomical origin. Femoral tunnel placement is the part of this operation that decides the outcome — a tunnel a few millimetres off changes how the graft tightens through the arc of movement, which is why the position is confirmed intra-operatively rather than judged by eye.

Bony Procedures When Indicated

Where the tibial tubercle sits too far laterally, or the patella rides high, a tibial tubercle osteotomy — moving and re-fixing the bony attachment of the patellar tendon — may be combined with the ligament reconstruction. Severe trochlear dysplasia is discussed separately. Not every unstable kneecap needs bony work, and we will tell you plainly when it does and when it does not.

Cartilage Assessment

Dislocations frequently shear cartilage off the patella or lateral femoral condyle. Loose fragments are addressed arthroscopically at the same sitting. Where cartilage is damaged but not detached, we set expectations honestly: the aim is a stable, functional knee, not a knee restored to its pre-injury cartilage.

Why Choose Our Clinic

Recurrent kneecap instability is commonly treated as a rehabilitation problem long past the point where rehabilitation can solve it. Dr. Sunku’s arthroscopy and sports medicine fellowship training, and his work as a team doctor for professional athletes, mean the assessment covers the bony anatomy and the alignment, not only the torn ligament — which is what determines whether one operation is enough. Imaging is ordered when it changes the plan. Where a brace and a proper strengthening programme will do, that is what you will be advised to do.

Recovery and Rehabilitation Overview

Week 0–2

Brace in extension for walking, crutches as needed. Focus on controlling swelling, regaining full extension, and switching the quadriceps back on. Most people are off crutches within this window.

Week 2–6

Progressive range of motion within the surgeon’s limits, closed-chain strengthening, and hip and core work. Brace weaned as quadriceps control returns.

Week 6–12

Full range of motion expected. Strength work intensifies, single-leg control and balance introduced, stationary cycling and swimming usually permitted.

Month 3–6

Running, then agility and change-of-direction drills once strength testing shows the operated leg is closing the gap on the other side. Not a calendar decision — a capability decision.

Month 6–9

Return to pivoting sport for those who need it, after clearance. Isolated MPFL reconstruction generally returns to sport sooner than a reconstruction combined with an osteotomy, which needs bone healing time.

Timelines vary with whether a bony procedure was added, the state of the cartilage, and how consistently rehabilitation is done. The single strongest predictor of a stable outcome is quadriceps and hip strength at the point of return — not the number of weeks elapsed.

Where we see Kneecap Instability Patients

Raghava Multispeciality

Centred at Attibele, on Sarjapura–Attibele Road. Ideal for people in Anekal, Chandapura, Jigani, Bommasandra, and Electronic City.

In-person Reviews

Health Nest Hospital

HSR Layout (24th Main, Sector 2). Convenient for HSR, Koramangala, BTM Layout, and Bellandur residents.

Follow-up Visits
If you are unsure which location to book, use the contact page and mention your pin code. Bring prior MRI or X-ray reports, a list of medicines, and comfortable clothing so the joint can be examined properly.

MPFL Surgery & Kneecap Dislocation FAQ

Usually not. A first-time dislocation without a loose cartilage or bone fragment is generally treated with a brace and a structured rehabilitation programme. Surgery is considered if a fragment needs removing or fixing, or if the kneecap dislocates again. An MRI after the first episode is worthwhile because it identifies the fragments and the anatomical risk factors that predict a second dislocation.
The medial patellofemoral ligament runs from the inner border of the kneecap to the femur and is the main restraint stopping the patella sliding outward in the first 30 degrees of bend. Once it has been torn and stretched by repeated episodes, stitching it back rarely restores its original tension. Reconstruction with a tendon graft gives a more predictable restraint, which is why it is the standard for recurrent instability.
In most patients with normal or near-normal bony anatomy, yes — restoring the ligament restores stability. Where the trochlear groove is very shallow, the kneecap sits high, or the tibial tubercle is too far to the outside, ligament reconstruction on its own carries a higher failure rate, and a bony procedure is discussed alongside it. This is exactly why the pre-operative measurements matter.
It is a procedure that moves the bony bump where the patellar tendon attaches, and fixes it in a corrected position with screws. It is added when measurements show the extensor mechanism pulls the kneecap too far laterally, or when the patella rides too high. Most patients do not need it. It adds bone-healing time to the recovery, so it is only recommended when the measurements justify it.
Desk-based work is usually possible in about two weeks, sometimes sooner if you can keep the leg elevated and travel is manageable. Work that involves standing all day, climbing, driving heavy vehicles, or squatting typically needs six to twelve weeks. If an osteotomy was performed, allow longer.
For a left knee in an automatic car, often within two to three weeks. For a right knee, it is generally six weeks or more — the test is whether you can perform an emergency stop without hesitation, not whether the knee feels comfortable resting on the pedal. Check your insurer’s position as well.
No, though arthroscopy is often performed at the same time to inspect the joint and deal with any loose cartilage. An MPFL reconstruction involves small incisions on the inner side of the knee to pass and fix the graft; it is a reconstruction of a ligament, not simply a keyhole clean-up.
Each dislocation carries a risk of shearing cartilage from the back of the kneecap and the outer femoral condyle. Over years, that cartilage damage is the mechanism by which recurrent instability turns into patellofemoral arthritis and persistent front-of-knee pain. Stabilising the kneecap is as much about protecting the joint surface as about confidence.

Book a Kneecap Instability Assessment in Bengaluru

If your kneecap has dislocated more than once, or you no longer trust the knee on stairs and turns, bring your MRI and X-rays for a proper assessment of the ligament and the underlying anatomy.

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Locations

  • • Raghava Multispeciality, Attibele
  • • Health Nest Hospital, HSR Layout

Related treatments & patient guides

Orthopedic and sports medicine care in Bengaluru

Dr. Nitin N Sunku is a consultant orthopedic surgeon and sports medicine specialist. His day-to-day work spans knee and shoulder arthroscopy, ACL and other ligament injuries, meniscus tears, cartilage-friendly repair options when suitable, hip and knee arthritis assessment, joint replacement when quality of life is clearly limited, fracture and trauma review, and spine symptom evaluation with a staged plan. Care is built around a clear history, a focused examination, imaging only when it changes management, and honest discussion of non-operative versus operative paths.

Where appointments take place

The practice is anchored at Raghava Multispeciality Hospital, Attibele, on Sarjapura–Attibele Road, for many patients travelling from Attibele, Anekal, Chandapura, Jigani, Bommasandra, Electronic City, Sarjapura, and nearby towns who want a South Bengaluru base close to home or work. Health Nest Hospital, HSR Layout (24th Main Road, Sector 2) supports selected consultations and follow-up for people who live closer to HSR, Koramangala, BTM Layout, Bellandur, or Whitefield-side commutes. Both sites link into imaging and physiotherapy networks when referrals are needed.

Conditions and procedures people commonly ask about

Typical questions cover ACL tears and post-injury instability, meniscus repair versus partial trimming, recurrent shoulder dislocation, rotator cuff tears and frozen shoulder, shoulder arthroscopy for impingement, tennis or golfer's elbow flare-ups, runner's knee and shin splints, Achilles and other tendon overuse problems, early to advanced hip and knee arthritis, partial and total knee replacement timing, hip replacement for arthritis and selected fractures, acute collarbone and ankle fractures, workplace and road traffic injuries, and back pain with or without leg symptoms when urgent red flags have been excluded. Sports medicine visits often blend training-load advice with targeted rehabilitation goals rather than rushing to surgery.

Before you attend

Bring photo ID, insurance cards if applicable, a concise list of medicines and allergies, old MRI or X-ray reports on phone or paper, and footwear or clothing that lets the knee or shoulder be examined. Write down three goals—for example, "sleep without waking from knee pain," "jog five kilometres without swelling," or "lift my child safely." Those goals help prioritise whether bracing, injections, structured physiotherapy, arthroscopy, or joint replacement is discussed first.

Using this website responsibly

Articles under the blog section explain common symptoms and treatment concepts in plain language. They are educational, may simplify complex decisions, and should always be confirmed in clinic after examination and, when needed, imaging. If you have severe deformity after injury, numbness or weakness in a limb, high fever with a hot swollen joint, chest pain, shortness of breath, or new bladder or bowel dysfunction with back pain, seek emergency care immediately rather than waiting for an outpatient slot.

You may book through the contact page, call the numbers in the footer, browse services and the gallery for facility context, or read testimonials to understand how recovery plans are communicated. For machine-readable orientation aimed at language models, this site publishes llms.txt.

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