Patellar Instability: A Narrative Review with an Integrated Treatment Algorithm

Area of Science:

• Orthopedics
• Sports Medicine
• Biomechanics

Background:

• Patellar instability involves recurrent patellar dislocation or subluxation, frequently impacting young, athletic individuals.
• Symptoms include apprehension, swelling, and fear of re-injury, arising from anatomical, soft tissue, and biomechanical factors.

Purpose of the Study:

• To synthesize current knowledge on patellar instability, covering pathoanatomy, diagnosis, and management.
• To provide an up-to-date overview for clinicians, including considerations for skeletally immature patients.

Main Methods:

• A narrative review of orthopedic literature was performed.
• Key areas included anatomical risk factors, diagnostic tools, classification systems, and treatment algorithms, integrating classical and recent findings.

Main Results:

• Accurate identification of factors like trochlear dysplasia and TT-TG distance is crucial for management.
• Conservative care suits first-time dislocators without risk factors; recurrent cases need tailored surgery (e.g., MPFL reconstruction, osteotomy).
• For skeletally immature patients, physeal-sparing techniques are vital to prevent growth disturbances.

Conclusions:

• A patient-specific,
• à la carte
• approach based on thorough assessment optimizes outcomes.
• Integrating anatomical, biomechanical, and developmental factors is essential for effective treatment and joint preservation.