Managing patellofemoral instability in in-season athletes: a review

Patellofemoral instability (PFI) is a relatively common injury in the young, athletic population and remains a significant source of knee pain and functional limitation. It most frequently affects athletes who participate in sports that involve repetitive jumping, cutting, and pivoting motions, such as basketball, soccer, and volleyball. During the competitive season, managing this condition becomes particularly challenging. Athletes are often eager to return to play, while clinicians must weigh the risks of early return against the need for sufficient recovery to prevent re-injury. As a result, in-season management continues to be a topic of ongoing discussion and debate. This review explores the comprehensive evaluation and treatment of PFI, with a focus on both non-surgical and surgical options. Non-surgical management, including rehabilitation and activity modification, is typically favored for first-time dislocations or in the absence of significant anatomical abnormalities. Surgical intervention is considered in cases of recurrent instability or when structural issues are identified. In addition to physical treatment, rehabilitation plays a central role in restoring strength, stability, and neuromuscular control. Equally important is psychological readiness, which is increasingly recognized as a critical factor in safely returning athletes to sport. A well-rounded approach that addresses both physical and mental recovery is essential for optimal outcomes.