When is it time to consider surgery (patella-femoral)?

by Heather
(Toronto)

I've been doing physiotherapy for my patella femoral injury for about 10 weeks now, and I haven't been making any progress in the last few weeks. The last few times I've been to my physiotherapist, she has advised me that I'm doing everything right and that I just need to keep at it... so I haven't been back in a couple of weeks but I'm still doing my exercises, trying to increase reps or weight if everything feels OK but I've plateaued.

My question is how much longer should I keep at this before I consider surgery? I've read just about everything I can about the injury, and I don't think there's anything more I could be doing physio wise... Thanks!

Heather, Toronto

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When is it time to consider surgery (patella-femoral)?

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Jun 29, 2008
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3 months if you aren't making progress
by: Bart - SII

Deciding to move on with surgery for patella femoral problems is not an easy decision. But if you are at a standstill with progress, it might be your next option.

Surgery should only be considered if you have exhausted all of the possible conservative efforts. That means you need to make sure that your rehab has focused on improving your flexibility and mobility, especially in your hamstrings, hip rotation, hip extension, lumbar extension, lumbar lateral flexion, and thoracic extension.

You need to make sure that you do not have biomechanical issues at the feet, such as overpronation, that are contributing to your patella femoral pain. If you do have these issues, some type of foot orthotic, like 1st Steps by Wrymark, should be utilized.

You also need to make sure that your rehabilitation efforts have addressed core and low abdominal weakness, hip abductor and hip external rotation weaknesses, neuromuscular patterns at the hip and core, as well as quadriceps and hamstring strength.

If you have covered all of these areas and are still not making progress, then surgery is probably the next option. The type of surgery should be dependent upon your symptoms as well as the mechanical state of your patella femoral joint. Lateral release is the most commonly used surgery for patella femoral problems, but it is most effective for treating lateral tilt. Other surgeries include medial reefing procedures, which are effective if you suffer from patella dislocation or subluxation.

I would discuss with your physician all of your options, and make sure that you have addressed possible hip/core weakness in your rehab before you consider surgery.

Hope this helps - comment back if you have other questions.

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Jun 29, 2008
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Submitted by: Bart - SII

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Deciding to move on with surgery for patella femoral problems is not an easy decision. But if you are at a standstill with progress, it might be your next option. Surgery should only be considered if you have exhausted all of the possible conservative efforts. That means you need to make sure that your rehab has focused on improving your flexibility and mobility, especially in your hamstrings, hip rotation, hip extension, lumbar extension, lumbar lateral flexion, and thoracic extension. You need to make sure that you do not have biomechanical issues at the feet, such as overpronation, that are contributing to your patella femoral pain. If you do have these issues, some type of foot orthotic, like 1st Steps by Wrymark, should be utilized. You also need to make sure that your rehabilitation efforts have addressed core and low abdominal weakness, hip abductor and hip external rotation weaknesses, neuromuscular patterns at the hip and core, as well as quadriceps and hamstring strength. If you have covered all of these areas and are still not making progress, then surgery is probably the next option. The type of surgery should be dependent upon your symptoms as well as the mechanical state of your patella femoral joint. Lateral release is the most commonly used surgery for patella femoral problems, but it is most effective for treating lateral tilt. Other surgeries include medial reefing procedures, which are effective if you suffer from patella dislocation or subluxation. I would discuss with your physician all of your options, and make sure that you have addressed possible hip/core weakness in your rehab before you consider surgery. Hope this helps - comment back if you have other questions.

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Apr 26, 2009
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my rehab
by: matt

yeah I am at the same stage...10 weeks physio...and my physio told me that it wasn't working and won't help me any further even though I followed the program and appt's to the letter. A week later had a review with my doctor and have been referred to a surgeon for possible options. My advice is to talk to your physio frequently on your treatment and be fair to both of yourselves on the progression (if any) of your knee.