Recent advances and future trends in patellofemoral instability

Abstract

Patellofemoral joint instability (PFJI) is a challenging condition affecting primarily young patients. It can be both physically and mentally disabling. There are numerous factors which contribute to stability of the patellofemoral joint and thorough clinical assessment and appropriate radiological investigations are essential in determining which risk factors need to be corrected to prevent further episodes of dislocation. One of the key operations utilized in the management of PFJI is medial patellofemoral ligament (MPFL) reconstruction, to restore the patellar restraint against lateral translation. The complications that can result from MPFL reconstruction can be largely divided into complications resulting from technical error or selection of operation for a patient’s specific risk factors. Some risk factors of PFJI can precipitate the need for additional operations being performed alongside MPFL reconstruction, including trochleoplasty, lateral retinacular lengthening, and tibial tuberosity osteotomy. Failure to identify the need for concurrent operations will result in persistent PFJI. This update article will outline the approach to assess a patient presenting with PFJI and the risk factors which should be identified and corrected. It will also cover the various management options with respect to these factors, with some important considerations for each.