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Ajay C Kanakamedala, Bradley A Lezak, Michael J Alaia

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|March 3, 2024

Summary

This review examines current controversies in patellar instability treatment. Recommendations include considering trochleoplasty for severe dysplasia and specific criteria for tibial tubercle osteotomy during MPFL reconstruction.

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Area of Science:

Orthopedic Surgery
Sports Medicine
Biomechanics

Background:

Recurrent patellar instability significantly impacts patient quality of life and function.
Recent research challenges traditional treatment principles for patellar instability.
This review focuses on three key areas: tibial tubercle-trochlear groove distance, tibial tubercle osteotomy with MPFL reconstruction, and medial patellar stabilizer reconstruction.

Approach:

The review synthesizes current evidence on patellar instability management.
It evaluates factors influencing tibial tubercle-trochlear groove distance.
It analyzes the indications for combined tibial tubercle osteotomy and medial patellofemoral ligament reconstruction.

Key Points:

Trochleoplasty should be considered for Dejour D trochlear dysplasia due to high failure rates of other techniques.
Tibial tubercle osteotomy improves outcomes in maltracking or positive J sign with TT-TG of 18-20 mm.
Isolated MPFL reconstruction may suffice for patients without maltracking and TT-TG up to 25 mm.

Conclusions:

While MPFL reconstruction has strong supporting data, alternative techniques like medial quadriceps tendon femoral ligament and hybrid methods show promise.
Surgeons should carefully consider patient-specific factors and imaging when deciding on surgical approach.
Further research is needed to fully elucidate the long-term efficacy of newer stabilization techniques.