Distal realignment procedures involve a repositioning of the structures of the kneecap. They are performed in order to correct patellofemoral instability, or a chronic dislocation of the kneecap. There are several types of distal realignment surgeries, but they all entail a shifting of the tendon that sits beneath the kneecap to align it better with the tibial tubercle, which is the bump on the shin bone of the lower leg found just below the knee.
Often, the need for a distal realignment procedure arises when there is evidence of patellar instability. Patellar instability is frequently the result of subluxation, a partial dislocation in the knee. It can cause symptoms including knee pain, a feeling that the kneecap is loose and a buckling of the knee. This area is where several tendons, ligaments and muscles are attached, so it is vulnerable to problems due to injury or because certain people are anatomically prone to the patella tracking slightly to the side.
Patellofemoral instability may in some cases be successfully treated with conservative measures that may include avoiding certain activities, performing exercises to strengthen the quadriceps muscle of the thigh and wearing a brace on the affected knee. However, in many patients, these methods do not provide significant relief of symptoms and a surgical alternative is necessary.
The surgeon will determine the best kind of distal realignment procedure to perform in each individual patient’s case. They are all variations on the same procedure but differ in how the tendon and tibia tubercle are moved and altered within the knee. The types of distal realignment procedures a surgeon may select include:
While each type of distal realignment procedure varies slightly in how the surgeon treats the tendon and tibial tubercle, all are typically performed with the patient under general anesthesia. The surgery is usually completed in 60 to 90 minutes. Sometimes a distal realignment is performed as an outpatient procedure, but it more often requires a one or two night hospital stay.
The surgeon will make an incision toward the lower front of the knee to gain access to the bone and tissue of the kneecap. The tibial tubercle is cut using specialized tools and moved slightly toward the inner side of the knee. The patellar tendon is then similarly moved and realigned as necessary. The portion of the tibial tubercle that was cut will be reattached and secured using metal screws. Once all of the structures have been repositioned as needed, the surgeon can suture the incision closed.
Patients typically experience some pain after a distal realignment procedure and pain medication is prescribed. Swelling in the knee is common, which usually responds well to keeping it in an elevated position and regularly applying ice for the first few days.
The treated knee will require some level of support and protection to promote healing, so generally either a cast or a knee immobilizer will be used. In addition, it is not safe to bear full weight on the knee for some time. Therefore, patients will have to use an assistive device such as crutches or a cane for up to six weeks after the procedure. Physical therapy is an important part of the recovery process as it helps the knee to regain strength, flexibility and complete functionality.
Patients can often return to sedentary jobs after three or four days. However, more physical types of employment and other active pursuits generally cannot be resumed for at least two months following surgery.
Distal realignment procedures are considered safe and effective forms of surgery. All surgical procedures do carry some risk, though. The risks typically associated with a distal realignment procedure may include infection, pain, prolonged healing of the bone and a decrease in range of motion in the knee.