Procedure: This is where a ligament (the MPFL) which hold the kneecap in central alignment and acts as check reign is reconstructed. This can be done using one of your own tendons (Gracilis autograft ) or a synthetic material can be used.

Recovery: around 6 weeks

Weight bearing: Full weight bearing with crutches

Procedure: This is a bigger operation where the front of the knee is exposed showing the shin bone where the patellar tendon attaches (tibial tubercle). As the problem sometimes is due to the fact that the patellar tendon is attaching too far to the side or the knee cap is too high; this part of the bone is removed from its original position (osteotomy) and re-placed in a better position to allow the knee cap to be more central or further down. This is then fixed back with screws.

Recovery: 6-12 weeks, whilst the bone heals back

Weight bearing: Partial (50%) weight bearing with crutches for 6 weeks and Full weight bearing after with or without crutches

Procedure: This is probably the most complex surgery for this type of problem. The surgery aims to create a deeper grove under the cartilage of the trochlea of the femur. The patella can then sit nicely and glide down the groove rather than side off to one side.

Mr Barkatali is currently the only surgeon in the UK able to do this via key hole surgery (arthroscopic) rather than open the whole knee as is the standard approach. The arthroscopic approach results in much less scarring and potentially better results.

Recovery: 12-24 weeks

Weight bearing: Full weight bearing with crutches

Treatment for patellar instability (PI) depends on the severity of the condition and the underlying cause. Non-surgical treatment options may include:

• Physical therapy: A physical therapist can teach you exercises to improve the strength and flexibility of the muscles around your knee, which can help stabilize your patella.
• Bracing: Wearing a knee brace can help support your patella and keep it from dislocating.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and pain.

If non-surgical treatment options are not effective, surgery may be necessary to repair or reconstruct the ligaments or other structures around the patella. The specific surgical procedure used will depend on the specific cause of the PI.

It's important to follow your treatment plan as directed to help ensure the best possible outcome

There are several surgical procedures that can be used to treat patellar instability (PI), including:

• Lateral release: This procedure involves cutting part of the lateral retinaculum (a thick band of tissue on the outside of the patella) to allow the patella to move more freely.
• MPFL reconstruction: The medial patellofemoral ligament (MPFL) is a ligament on the inner side of the patella that helps to stabilize it. If the MPFL is stretched or torn, it can be reconstructed using a piece of tissue from another area of the knee or using a synthetic graft.
• Tendon transfer: This procedure involves transferring a tendon from one part of the leg to the patella to help stabilize it.
• Osteotomy: This procedure involves cutting and repositioning the bone around the patella to improve its alignment.

The specific surgical procedure used will depend on the specific cause of the PI

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After patellar instability surgery, it's important to follow the specific rehabilitation plan recommended by your surgeon and physical therapist. This will typically involve a period of rest and immobilization followed by a gradual return to activities. Your physical therapist will design a program of exercises to help you regain strength and flexibility in your knee.

Here are some examples of exercises that may be included in your rehabilitation program:

• Quadriceps strengthening exercises: These exercises target the muscles at the front of your thigh, which help to stabilize your patella. Examples include leg presses and leg extensions.
• Hamstring stretching: Tight hamstrings can contribute to patellar instability, so it's important to keep these muscles flexible. Hamstring stretches can be done while lying on your back or sitting with one leg extended.
• Step-ups: Step-ups can help to improve balance and leg strength. Stand in front of a step or bench and step up onto it with one leg, using your leg muscles to lift your body up.
• Lunges: Lunges are another great exercise for improving leg strength and balance. Step forward with one leg and bend your knees, lowering your body down until your thighs are parallel to the ground.

Again, it's important to follow the specific rehabilitation plan recommended by your surgeon and physical therapist. It's also important to avoid activities that could put undue strain on your knee until you have fully recovered.