Editorial Commentary: Treating Patients With Recurrent Patellar Instability With an Individualized, Anatomic Approach...

Treatment algorithms for recurrent patellofemoral instability have evolved over time. Early treatment techniques focusing specifically on pain have been replaced by evidence-based and anatomically appropriate procedures such as ligament reconstruction, osteotomies, and trochleoplasty. Bony and soft-tissue factors contribute to recurrent patellofemoral instability, but the exact indications for soft-tissue, bony, and combined procedures remain controversial. Personally, I am much more likely to combine tibial tubercle osteotomy with medial patellofemoral ligament reconstruction in a patient with trochlear dysplasia, patella alta, and a large J-sign (in addition to an elevated tibial tubercle to trochlear groove distance). As in cases of anterior cruciate ligament injury, in cases of patellofemoral instability we must consider bony morphologic features in addition to soft-tissue status.