i have had the realignment surgery. im sure there are cases that are more severe than others so ill just explain my experience. the first time i had a problem was 7th grade performing the "long jump" in gym class. i guess i came down more on my left foot and my knee just buckled out. it was a ridiculous amount of pain and the doctor told me that i tore a ligament. i was in a knee mobilizer for a while and that was that. during 8th grade i must have blown my knee out at least every other month.
however, since i thought i knee what was going on, i would roll around on the ground for a minute, long enough to calm myself down and slowly stretch my leg back out and then get myself off the ground. then i started wearing a cheap, but effective, ace knee wrap i got at k-mart whenever i had gym class or played sports. in high school i played hockey, and every so often making sharp turns and such my knee would just go out and id slide across the ice until something, usually the boards, stopped me.
during my junior year, being a drunken idiot at my friends house i jumped over a couch and that was about all she wrote for my knee. up until this point, when my knee went out it would be swollen, and gradually get stronger over a few days until it was back to at least being stable. this time it took a bit longer, i sucked on the ice for probably a week+ and at that point i went to the doctors. he told me i needed surgery to realign the knee cap as well as arthroscopic surgery to clean out all the scar tissue, because i had at some point or another, torn just about everything in there at least once. luckily, the season was over soon so i decided to wait a little bit.
anyway, i had the surgery, which for me meant cutting off the tip of one of the shin bones and screwing it back in about 1/4 inch over. he also scoped three spots. my knee has not gone out since. it definitely took a long time to build back any type of strength though. every now and then if i step on an unever surface or something it feels like it did just before the point where it would buckle and id be on the ground, but it never goes past that point, and im not sure if it will, because either way its a quick little jolt telling me to stop doing whatever im doing real quick.
also, the tip of the bone that has screws in it used to get pretty sore, i think because the tendon wasnt used to stretching to its new position or something, but that went away and the "bad" knee is virtually the same as the "good" one. it was also a pain in the ass doing squats and leg presses and such for a while because the "good" leg would do much more of the work and on leg day and the days after it felt ridiculous.
definitely go back to the doc and get the thing x-rayed. its not as bad of a surgery as its made out to be. first day or so after was very uncomfortable but after that its fine. also the doc told me 2-3 months of crutches, but i went to one crutch a day or so after and no crutches 4 days after the surgery. good luck