Patellofemoral Instability & Pain
Understanding kneecap instability and pain in the front of the knee
Patellofemoral instability and pain are common conditions affecting the front of the knee, particularly around the kneecap (patella). These issues can cause discomfort, reduced confidence with movement, and difficulty performing everyday or sporting activities. Dr George Awwad provides a thorough assessment and personalised treatment plans to help patients better manage patellofemoral symptoms and restore knee function.
What is patellofemoral instability?
The patellofemoral joint is where the kneecap (patella) meets the thighbone (femur). This joint plays a crucial role in knee movement, especially during activities like climbing stairs, running, or squatting.
Patellofemoral instability occurs when the kneecap does not track properly within its groove (the trochlea) during movement. This may lead to:
- Partial or complete dislocation of the kneecap
- A sensation that the kneecap is “slipping out” or unstable
- Recurring pain or swelling in the front of the knee
Instability may be caused by structural differences, soft tissue imbalances, or a previous dislocation injury that has weakened the stabilising ligaments around the knee.
What causes patellofemoral pain and instability?
Several factors may contribute to instability or pain in the patellofemoral joint:
- Previous dislocation or subluxation of the kneecap
- Shallow trochlear groove (trochlear dysplasia)
- Tight or imbalanced muscles around the hip and knee
- Hypermobile joints or generalised ligamentous laxity
- Abnormal patella height (patella alta)
- Lateral pull from tight structures on the outside of the knee
- Improper alignment of the lower limb or foot
In adolescents and young adults, patellofemoral pain may also be related to overuse, growth-related changes, or muscle weakness.
Symptoms of patellofemoral instability and pain
Common symptoms include:
- Pain at the front of the knee, especially with stairs, squatting, or prolonged sitting
- A feeling of the kneecap being unstable or moving out of place
- Swelling or puffiness around the patella
- Clicking, popping, or grinding with movement
- Loss of confidence in knee movement or sporting activity
- Visible dislocation or a history of the kneecap “popping out”
These symptoms can vary from mild discomfort to severe instability that interferes with daily activities.
Diagnosis and assessment
Dr Awwad performs a detailed clinical evaluation to identify the cause of your symptoms and tailor treatment appropriately.
The assessment may include:
- A comprehensive history, including details of any dislocations or injuries
- Physical examination to assess patella tracking, muscle strength, joint flexibility, and alignment
- X-rays to examine patella position and joint structure
- MRI or CT scans to evaluate soft tissues, cartilage, and bone anatomy
Understanding the underlying cause of patellofemoral symptoms is essential to selecting the most appropriate treatment pathway.
Treatment options for patellofemoral conditions
Treatment is tailored based on your symptoms, anatomy, and functional goals.
Non-surgical treatment
Many cases of patellofemoral pain and mild instability can be managed with:
- Physiotherapy: Strengthening the quadriceps, gluteal muscles, and core can improve knee alignment and patella tracking
- Stretching programs: Addressing tight structures such as the lateral retinaculum or iliotibial band
- Bracing or taping: May provide support or improve patella position during activity
- Activity modification: Avoiding aggravating activities and gradually returning to sport
- Orthotics or footwear changes: Helpful if foot alignment contributes to symptoms
- Medications: Anti-inflammatory options may assist with symptom relief in some cases
Dr Awwad works closely with physiotherapists to guide your rehabilitation and progress.
Surgical treatment
Surgical intervention may be considered when:
- There is recurrent dislocation or instability
- Conservative measures have failed to relieve symptoms
- Structural abnormalities (e.g. trochlear dysplasia, patella alta, or malalignment) require correction
Procedures Dr Awwad may discuss with you include:
- Medial Patellofemoral Ligament (MPFL) Reconstruction: Rebuilding the ligament that helps keep the patella in place
- Tibial Tubercle Osteotomy (TTO): Realigning the attachment point of the patellar tendon to improve patella tracking
- Trochleoplasty: Deepening a shallow groove in the femur (for severe dysplasia)
- Lateral Release: Releasing tight structures pulling the kneecap outwards
- Arthroscopy: To assess and treat cartilage or soft tissue damage
Dr Awwad will recommend surgery only when appropriate and after careful assessment of your anatomy and lifestyle needs.
Book a consultation
If you’re experiencing kneecap instability, dislocation, or ongoing pain at the front of your knee, Dr George Awwad can provide a detailed assessment and discuss the best treatment options for you.