DR. ONG KEE LEONG
Kneecap (Patella) Stabilisation Surgery
Kneecap (patella) stabilisation surgery encompasses various procedures designed to correct patellar instability, a condition where the kneecap dislocates or moves out of its normal position within the trochlear groove of the femur. These procedures, including medial patellofemoral ligament (MPFL) reconstruction, tibial tuberosity osteotomy (TTO), and trochleoplasty, aim to restore proper alignment and function of the patellofemoral joint, reducing the risk of recurrent dislocations and associated pain.
Book AppointmentPotential Risks and Complications
While generally successful, kneecap stabilisation surgery carries potential risks including infection, blood clots, anaesthetic complications, and hardware problems. Procedure-specific complications may include graft failure or stretching after MPFL reconstruction, nonunion of bone after TTO, persistent pain, stiffness, or continued instability. Cartilage damage can occur despite surgery, and some patients may experience decreased knee flexion or extensor mechanism problems. The rehabilitation period can be lengthy, and full recovery is not guaranteed for all patients.
Indications for Kneecap Stabilisation Surgery
Patients may be recommended kneecap stabilisation surgery based on several clinical findings and symptoms that affect quality of life and knee function.
- Recurrent Patellar Dislocations: Multiple episodes of kneecap displacement that occur during normal activities or sports, indicating structural instability that may not respond to non-surgical management.
- Failed Conservative Treatment: Persistent symptoms and instability despite completing appropriate physiotherapy, bracing, and activity modifications over a sufficient period.
- Anatomical Abnormalities: Structural issues such as patella alta (high-riding kneecap), trochlear dysplasia (shallow groove in the femur), or increased tibial tuberosity-trochlear groove (TT-TG) distance that predispose to instability.
- Cartilage Damage: Evidence of articular cartilage injury resulting from patellar maltracking or dislocations, which may progress to arthritis if alignment is not corrected.
Benefits of Kneecap Stabilisation Surgery
- Enhanced Joint Stability: The procedures restore normal biomechanics of the patellofemoral joint, reducing or eliminating the risk of future dislocations during daily activities and sports.
- Pain Reduction: Correcting the underlying anatomical issues often leads to decreased pain as the kneecap tracks properly and pressure is distributed evenly across joint surfaces.
- Improved Function: Patients typically experience better knee function after recovery, allowing return to activities that were previously limited by instability or pain.
- Prevention of Secondary Damage: Stabilising the kneecap helps prevent further cartilage damage and reduces the risk of developing early osteoarthritis from repeated trauma to the joint.
Surgical Techniques
MPFL Reconstruction
This procedure recreates the medial patellofemoral ligament, which is the primary soft tissue restraint preventing lateral patellar displacement. A graft (typically from hamstring tendons) is secured to the inner edge of the kneecap and anchored to the femur at the anatomical attachment site. This technique is suitable for patients with intact cartilage and minimal anatomical abnormalities.
Tibial Tuberosity Osteotomy (TTO)
This technique involves cutting and repositioning the tibial tuberosity (the bump at the top of the shin bone where the patellar tendon attaches). The bone fragment is usually moved medially (toward the inside), anteriorly (forward), or distally (downward) and secured with screws. TTO addresses issues such as excessive lateral tracking forces or patella alta.
Trochleoplasty
This more complex procedure reshapes the trochlear groove of the femur to create a deeper channel for the kneecap to track within. A section of bone is removed from beneath the cartilage, the groove is deepened, and the cartilage is secured back in place. This technique is reserved for cases with significant trochlear dysplasia that cannot be adequately addressed by other methods.
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For Singaporeans & Singapore Permanent Residents
Preparing for the Procedure
- Medical Evaluation: A thorough assessment, including physical examination, imaging studies (X-rays, MRI), and laboratory tests, determines surgical eligibility and helps plan the specific procedure. The surgeon will review medical history and current health status to identify risk factors.
- Medication Adjustments: Certain medications, particularly blood thinners, non-steroidal anti-inflammatory drugs, and supplements, may need to be temporarily discontinued prior to surgery. The surgeon will provide specific instructions about which medications to stop and when.
- Pre-operative Guidelines: Patients typically need to fast for at least 6-8 hours before surgery. Showering with antiseptic soap may be recommended, and smoking should be avoided as it can impair healing and increase complication risks.
Post-Surgical Care and Recovery
- Immediate Care: The initial recovery period involves pain management, wound care, and protection of the surgical site. Ice, elevation, and prescribed pain medications help control swelling and discomfort. A knee brace or immobiliser may be required for several weeks to protect the repair.
- Rehabilitation: A structured physiotherapy protocol typically begins shortly after surgery and progresses through stages of motion recovery, weight-bearing, strength building, and functional training. The timeline varies by procedure, with MPFL reconstruction generally allowing faster progression than TTO or trochleoplasty.
- Activity Restrictions: Weight-bearing limitations depend on the specific procedure performed. MPFL reconstruction may allow earlier weight-bearing, while TTO and trochleoplasty typically require 4-6 weeks of protected weight-bearing until bone healing occurs. Return to sports usually takes 6-12 months.
- Follow-up: Regular check-ups monitor healing progress and guide advancement of rehabilitation. These typically occur at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year post-surgery, with imaging studies to assess the healing of bone and soft tissues.
Step-by-Step Procedure
Anaesthesia Administration
The procedure begins with administration of anaesthesia, typically general anaesthesia, though regional anaesthesia may be used in some cases. This ensures the patient remains comfortable and unconscious throughout the operation.
Diagnostic Arthroscopy
The surgeon performs an arthroscopic examination of the knee joint through small incisions. This allows assessment of cartilage surfaces, ligaments, and menisci to confirm the surgical plan or identify additional issues requiring attention.
Surgical Approach
For MPFL reconstruction, incisions are made to harvest the graft (if using autograft) and to access the medial aspect of the patella and femoral attachment site. For TTO, an incision is made over the tibial tuberosity. Trochleoplasty requires a larger incision for adequate exposure of the trochlea.
Primary Procedure
The selected technique is performed—MPFL graft preparation and fixation, bone cutting and repositioning for TTO, or groove reshaping for trochleoplasty. Fixation devices such as screws, suture anchors, or buttons are used to secure tissues or bone in the desired position.
Wound Closure and Dressing
After the procedure is completed and stability is confirmed, the incisions are closed in layers using sutures or staples. Sterile dressings are applied, and the knee may be placed in a brace to protect the repair during initial healing.
Why Do Patients Choose Dr Ong Kee Leong?
- Dr. Ong Is Passionate In Sports, Giving Him A Deep Understanding Of Sports-Related Injuries And How They Can Be Treated
- Personalised And Professional Approach To Deliver High-Quality Orthopaedic Care Based On The Most Up-To-Date Literature
- Detailed Aftercare Plan To Ensure Smooth, Long-Term Recovery
- Fellowship Trained Surgeon With 15 Years Of Experience In Orthopaedic Conditions
- Problem-Oriented, Well-Organised and Individualized Treatment Plans Catered To Your Specific Needs
- Specialist In The Management Of Sports Injuries And Degenerative Conditions Of The Shoulder And Knee Joints
- Knowledgeable And Pleasant Clinical Staff To Assist You With Your Every Need Detailed Aftercare Plan To Ensure
- Our Care Is Conveniently Accessible At Mount Elizabeth Novena and Farrer Park Hospital
- Minimal Waiting Time For Initial Consultation
- Assistance With Medical Claims (e.g. Medisave & Integrated Shield Plans)
About Dr. Ong Kee Leong
Senior Consultant, MBBS (Singapore), MMed (Ortho), FRCSEd (Ortho)
Dr. Ong Kee Leong is a fellowship-trained orthopaedic surgeon. He subspecializes in shoulder and knee, foot and ankle, hand wrist and elbow surgeries, arthroscopic sports surgery, and the management of sports-related injuries.
He has been registered with the Singapore Medical Council as a specialist in Orthopaedic Surgery since 2011.
- MBBS, National University of Singapore (NUS) Faculty of Medicine 2001
- Member of the Royal College of Surgeons of Edinburgh 2007
- Master of Medicine in Orthopaedic Surgery (NUS) 2007
- Fellow of the Royal College of Surgeons of Edinburgh in Orthopaedic Surgery 2011
- Health Manpower Development Plan (HMDP) Scholarship, Ministry of Health 2012-2013:
- Sports Surgery and Arthroscopy in Germany (Hannover)
- Adjunct Assistant Professor, Lee Kong Chian School Of Medicine, Nanyang Technological University
- Senior Clinical Lecturer, Yong Loo Lin School of Medicine, NUS
Awards & Teaching
- Dr. Ong had received numerous awards such as Best Service and Eastern Health Alliance Caring (Gold) Awards.
- He also has an interest in clinical research and has written papers in multiple peer-review journals. As a Core Faculty of Singhealth Orthopaedic Surgery Residency Program, he oversees the training of junior orthopaedic surgeons.
- Regularly invited to teach local and regional surgeons in Shoulder and Knee Surgery Courses.
- He is a recipient of multiple teaching awards including the Singhealth Residency Outstanding Faculty Awards from 2014-2016 and Changi General Hospital Outstanding Educator Awards 2015-2016.
Frequently Asked Questions
Will the hardware (screws, anchors) need to be removed later?
Hardware removal is not routinely necessary unless it causes symptoms such as local pain or irritation. Some patients may require removal of screws after TTO due to discomfort, typically performed as a minor procedure after complete bone healing has occurred.
How soon can I return to sports after surgery?
Return to sports is individualised based on the specific procedure, healing progress, and rehabilitation milestones. Light activities like swimming may begin around 3 months, running at 4-6 months, and contact or pivoting sports typically at 9-12 months after confirming adequate strength and function.
Can these procedures be performed arthroscopically?
While diagnostic arthroscopy is commonly performed during these surgeries, the main stabilisation procedures typically require open incisions. MPFL reconstruction uses smaller incisions than TTO or trochleoplasty, but none are fully arthroscopic due to the need for tissue or bone manipulation and fixation.
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our clinics
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Mt Elizabeth Novena
- 38 Irrawaddy Road #06-59/60/61 Mt Elizabeth Novena Specialist Centre Singapore 329563
- klong@sog.sg
- (65) 6884 6788
- (Ask for Dr Ong)
- (65) 9652 5022
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Mon – Fri : 9:00 am – 5:00 pm
Sat : 9:00 am – 1:00 pm
other practice locations
Farrer Park Hospital
- 1 Farrer Park Station Road #14-06 Connexion Singapore 217562
- klong@sog.sg
- (65) 6884 6788
- (Ask for Dr Ong)
- (65) 9652 5022
-
Mon – Fri : 9:00 am – 5:00 pm
Sat : 9:00 am – 1:00 pm
Mt Alvernia Medical Centre
- 820 Thomson Road #07-53 Mt Alvernia Medical Centre D Singapore 574623
- klong@sog.sg
- (65) 6884 6788
- (Ask for Dr Ong)
- (65) 9652 5022
-
Mon – Fri : 9:00 am – 5:00 pm
Sat : 9:00 am – 1:00 pm
"Moving your body the way nature intended is a freedom not well appreciated until it is lost. We are passionate about getting you back in the game, and staying in the game. Our team is fully committed to returning you to the life and activities you love."
Billing & Payment
Consultation fees are charged based on length of consultation, and start from SGD$200 (within 30 minutes).
Modes of Payment
We accept the following modes of payment:
- Cash
- PayNow & PayLah
- All major Credit Cards
If you are insured and would like to use a Letter of Guarantee (LOG) from the major insurers in Singapore, please contact us and our friendly clinic staff will assist you and provide more information if required.
Can I Claim Through My Medisave Account? (For Singaporeans and PR)
Yes, you can. Our Clinic is an accredited day surgery clinic by the Ministry of Health. Singaporeans and Permanent Residents may use their Medisave for eligible orthopaedic inpatient procedures and hospitalizations.
The exact amount would depend on the complexity of the procedure. If you have any enquiries, feel free to speak to our friendly clinic staff about using your Medisave account.
Integrated Shield Plans (Singaporeans and PRs)
Yes, patients who have purchased Integrated Shield plans with riders for co-insurance and deductibles will be able to use them in our clinic for eligible procedures. For more information, contact us to find out if your procedure is claimable.
The 5 Approved Integrated Shield Insurers are:
- NTUC Income’s IncomeShield and Enhanced IncomeShield
- American International Assurance International Co’s (AIA) HealthShield Gold
- Great Eastern Life Assurance Co’s SupremeHealth and SupremeHealth Plus
- Prudential Assurance Co’s PRUShield
- AXA Shield