Patellofemoral disorders and instability

Area of Science:

• Orthopedic Surgery
• Biomechanics
• Sports Medicine

Background:

• Patellar instability, or a "slipping patella," has historically been linked to conditions like patella alta, ligamentous laxity, and muscle imbalances.
• Previous treatments focused on strengthening the quadriceps muscle, particularly the vastus medialis, and addressing muscle imbalances.
• Anatomical abnormalities were also recognized as contributing factors to patellar instability.

Purpose of the Study:

• To review the evolution of understanding and treatment for patellar instability.
• To highlight the importance of pathoanatomic basis in guiding surgical interventions.
• To consolidate knowledge on various surgical procedures for patellar stabilization.

Main Methods:

• Review of historical and contemporary literature on patellar instability treatments.
• Analysis of surgical techniques including extensor mechanism realignment, capsular reefing, and tendon transfers.
• Examination of bone-related procedures such as femoral condyle augmentation and trochleoplasty.

Main Results:

• Various surgical interventions have been developed, addressing both soft tissue and bony abnormalities.
• Procedures include proximal extensor mechanism realignment, capsular reefing, and patellar tendon transfers.
• Bone procedures like tibial tubercle transfer and trochleoplasty have also been employed.

Conclusions:

• A comprehensive understanding of the pathoanatomic basis is crucial for effective patellar stabilization.
• Treatment strategies have evolved from conservative measures to complex surgical reconstructions.
• Addressing underlying anatomical factors alongside muscle function is key to managing patellar instability.