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Abstract
Recent years have been characterized by an ongoing increase in knowledge about the different conditions associated with lateral patellar instability. This increase in knowledge provides differentiated approaches to the various pathologies of the patellofemoral joint. Though current guidelines consider medial patellofemoral ligament (MPFL) reconstruction the basic treatment for the unstable patella, medial soft tissue–stabilizing procedures should not be interpreted as stand-alone procedures in every case. The influence of different anatomical factors leading to patellar instability, as well as their impact on clinical outcome measures, is becoming increasingly apparent and deserves further attention. Therefore, the purpose of this review was to summarize recent developments in lateral patellar instability beyond MPFL reconstruction techniques. For this goal, the literature published within the last 3 years considering all aspects of lateral patellar instability was analysed. Six main topics evolved according to the number of publications and in terms of novel aspects and recent developments in the evaluation and treatment of lateral patellar instability. Those topics formed the basis of this article: (1) treatment of first-time patellar dislocation, (2) the impact of trochlear dysplasia and trochleoplasty procedures, (3) the relevance of torsional deformities, (4) patellar instability in open physis, (5) the implementation of new outcome measures, and (6) rehabilitation after patellar stabilizing procedures.
Highlights
The discovery of the medial patellofemoral ligament (MPFL) and the development of MPFL reconstruction techniques was the decisive milestone in the treatment of lateral patellar instability within the last 10–15 years
Exclusion criteria were case-reports, articles published in a language other than English or German, articles related to total knee arthroplasty, medial patellar instability, and studies from veterinary medicine
During the evaluation process of the 566 remaining titles and abstracts, six main topics evolved according to the number of publications that discussed them and in terms of novel aspects and recent developments in evaluation and treatment of lateral patellar instability
Summary
The discovery of the medial patellofemoral ligament (MPFL) and the development of MPFL reconstruction techniques was the decisive milestone in the treatment of lateral patellar instability within the last 10–15 years. Many different MPFL reconstruction techniques have been developed, which, if carried out correctly, provide good to excellent clinical results with low redislocation rates. For this reason, current guidelines consider MPFL reconstruction to be the basic treatment for lateral patellar instability (Liebensteiner et al 2017). The influence of different anatomical factors leading to patellar instability, as well as their effect on clinical outcome measures, is becoming increasingly apparent and deserves further attention.
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