[Patellar instability : diagnosis and treatment].

Area of Science:

• Orthopedic Surgery
• Biomechanical Analysis
• Sports Medicine

Background:

• Patellar instability is a common orthopedic condition.
• Anatomical factors contribute significantly to patellar instability.
• Current management strategies vary, with a need for refined approaches.

Purpose of the Study:

• To present recent advances in the surgical management of patellar instability.
• To classify anatomical factors contributing to patellar instability.
• To propose a staged surgical approach for recurrent patellar instability.

Main Methods:

• Classification of anatomical factors into extra-articular (valgus, torsion deformity) and articular (trochlea/patella dysplasia, tibial tubercle lateralization, MPFL insufficiency).
• Review of current surgical techniques for acute and recurrent patellar dislocations.
• Description of a two-stage surgical approach: extra-articular correction followed by articular correction.

Main Results:

• Acute patellar dislocations are typically managed conservatively, except for osteochondral and MPFL avulsion fractures.
• Recurrent patellar instability often requires surgical intervention.
• A two-stage surgical approach allows for staged correction of contributing factors and separate rehabilitation.

Conclusions:

• A comprehensive understanding and classification of anatomical factors are crucial for managing patellar instability.
• A two-stage surgical approach, addressing extra-articular and then articular factors, is preferred for recurrent patellar instability.
• This staged approach facilitates tailored rehabilitation protocols and potentially optimizes treatment outcomes.