Diagnosis and Characterization of Patellofemoral Instability: Review of Available Imaging Modalities

Patellofemoral instability (PI) is defined as single or multiple episodes of patellar dislocation. Imaging modalities are useful for characterization of patellar malalignment, maltracking, underlying morphologic abnormalities, and stabilizing soft-tissue injuries. Using these findings, orthopedic surgeons can decide when to operate, determine the best operation, and measure degree of correction postoperatively in PI patients. Also, these methods assist with PI diagnosis in some suspicious cases. Magnetic resonance imaging is the preferred method especially in the setting of acute dislocations. Multidetector computed tomography allows a more accurate assessment for malalignment such as patellar tilt and lateral subluxation and secondary osteoarthritis. Dynamic magnetic resonance imaging and 4-dimensional computed tomography have been introduced for better kinematic assessment of the patellofemoral maltracking during extension-flexion motions. In this review article, we will discuss the currently available evidence regarding both the conventional and the novel imaging modalities that can be used for diagnosis and characterization of PI.