Focus on the tubercle transfer: Avoid complications, choose fixation

Surgical treatment of patellar instability has many components and successful outcomes have been reported with many different techniques. Colvin and West noted that more than 100 different surgical techniques or variations for treatment of patellofemoral instability existed in the orthopaedic literature. They also appropriately note that “instability of the patellofemoral joint is a multifactorial problem. Patellar stability relies on the limb alignment, the osseous architecture of the patella and the trochlea, the integrity of the soft tissue constraints, and the interplay of the surrounding muscles.”

What is fascinating today is that we have a multitude of surgical procedures that can deal with almost any anatomic factor noted in this review. Medial patellofemoral ligament reconstruction and lateral release (soft tissue constraints), trochleoplasty (osseous architecture) and tibial tubercle osteotomy (patellofemoral alignment and muscle balance) are all popular methods for treating recurrent patellar instability. Many of these common surgical methods can be combined in order to potentiate the overall effectiveness of surgical intervention. Each of the surgical methods can supplement the others by changing one aspect of the overall patellofemoral joint anatomy.

To read the full Patellofemoral Update blog by Jeffrey T. Sprang, MD, click here.