Failure of Patellofemoral Joint Preservation

Abstract

Abstract Patellofemoral instability is a common problem, but surgical management of patients with patellofemoral instability is complex. Surgical intervention is typically indicated for patients with recurrent dislocations, but surgery may be indicated even in first-time dislocators if there is a concomitant cartilage injury or if the patient has a poor prognosis based on evolving risk factors. Cartilage repair should be performed if possible, and additional procedures such as medial patellofemoral ligament (MPFL) reconstruction and/or tibial tubercle osteotomy (TTO) can be performed in conjunction with cartilage procedures. However, surgical decision-making and preoperative planning can be challenging. In this article, we outline the authors’ preferred techniques for performing these primary procedures in addition to recommendations to help avoid complications which can arise following MPFL reconstruction and TTO. The aims of this review are 1) to describe the indications and contraindications to the surgical procedures which can be utilized in the treatment of patellofemoral instability and associated cartilage injury, 2) to outline recommendations which can help when performing these procedures in the primary setting, and 3) to describe case examples which required revision procedures.