[Osteotomies]

Skeletal geometry, soft tissues, and neuromuscular control influence the patellofemoral gliding mechanism. Abnormal skeletal geometry - such as increased femoral anteversion, trochlear dysplasia, patella alta, increased tibial external torsion, increased tibial tubercle lateralization, and variations of combined deformities - may lead to patellofemoral complaints. Altered vectors and forces acting on the patellofemoral joint can cause cartilage failure with later arthrosis, instability, and musculotendinous insufficiency. Osteotomy with soft tissue repair might be the best treatment, depending on the primary pathology. Surgery aims to eliminate the underlying pathomorphology.