Evaluation and management of patellar instability.

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Abstract

Conflict of interest statement: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/aoj-2020-02). The series “Sports Related Injuries of the Female Athlete” was commissioned by the editorial office without any funding or sponsorship. BESS reports personal fees from Arthrex, outside the submitted work. In addition, a member of her family receives royalties from Arthrex, outside of the submitted work. The authors have no other conflicts of interest to declare. 18. Semin Musculoskelet Radiol. 2025 Feb;29(1):60-75. doi: 10.1055/s-0044-1791836. Epub 2025 Feb 11. Patellofemoral Instability: Preoperative Considerations and Postoperative Imaging. Atinga A(1), Wasserstein D(2), Sidhu MS(2), Tomescu S(2), Probyn L(1). Author information: (1)Department of Medical Imaging, Temerty Faculty of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. (2)Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. Patellofemoral instability is common, often affecting young female patients. It contributes to significant morbidity, such as pain and premature osteoarthritis. Patient presentation varies, from acute instability events to chronic/recurrent instability. This article provides a detailed description of the anatomy and biomechanics of the patellofemoral joint and relates it to the pathology of patellofemoral instability. There are well-recognized predisposing anatomical factors, such as trochlear morphology, patella height, excessive lateralization of the tibial tubercle, excessive valgus alignment, and femoral or tibial torsion.Diagnosis of patellofemoral instability requires a thorough clinical history and physical examination, combined with a multimodality imaging approach. Imaging is useful in surgical planning to define the severity of predisposing anatomical factors and to detect postoperative complications. The operative management of patellofemoral instability targets predisposing anatomical factors, such as medial stabilizing ligament reconstruction or repair, tibial tubercle osteotomy, femoral trochleoplasty, coronal plane realignment osteotomy, and torsional osteotomy. Thieme. All rights reserved. DOI: 10.1055/s-0044-1791836