Failed Surgery

If previous surgery has failed to provide improvement or made the problem worse, the underlying problem should be determined if possible.  This is often possible by a good history, examining the untreated knee, and x-ray evaluation.  The surgery that was done needs to be evaluated for the changes it has made and how they have effected the knee.  The presence and degree of arthritis needs to be determined.

A surgical plan for correction needs to be developed based on all of these factors.  Arthroscopy is required for accurate assessment of the patellar position, stability, articular surfaces, and the remainder of the joint.

Lateral and medial side soft tissues and tibial tubercle position need to be evaluated.  Previous lateral release may need repair and the lateral retinaculum often has not been adequately released where it is tight, at the inferior patella.  The tibial tubercle may need revision if the position is not satisfactory even if there has been previous tibial tubercle transfer.  Poor tibial tubercle position will cause scarring and increase pressure.  The position and orientation of the tubercle must be corrected.  The medial soft tissues may also need repair.  Patello-femoral joint replacement may be required if arthritis is significant.

If all areas are treated appropriately, improvement should be expected.  Revision surgery can be very successful if approached in a systematic manner.