Recent developments in evaluation and treatment of lateral patellar instability

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.

Computational approach to correcting joint instability in patients with recurrent patellar dislocation

“…Patients with recurrent dislocation typically have abnormalities of knee anatomy and soft tissue integrity, with substantial inter‐subject variability. Clinical interventions that are tailored to the anatomy and mechanics of the individual patient may have benefit in optimizing post‐operative joint stability …”

“…Clinical interventions that are tailored to the anatomy and mechanics of the individual patient may have benefit in optimizing post-operative joint stability. [23][24][25] Patients with persistent symptoms of patellar instability are candidates for surgical interventions, with treatment options that include MPFL reconstruction, tibial tubercle osteotomy, sulcus-deepening TP, or combinations of these procedures. 1,[26][27][28] However, currently, there is no universally accepted algorithm for choosing the appropriate procedure(s) for a particular individual.…”

Does surgical treatment produce better outcomes than conservative treatment for acute primary patellar dislocations? A meta-analysis of 10 randomized controlled trials

“…This may have been caused by factors such as the study design, demographic characteristics, intervention treatments, followup duration, and even the scoring system itself. Kujala score is the most commonly used method to evaluate patellofemoral joint disease in recent years [12]. Whereas, there is a growing debate about whether the scoring adequately reflects the complexity of patellar instability [34].…”

“…Whereas, there is a growing debate about whether the scoring adequately reflects the complexity of patellar instability [34]. A new assessment score called the Norwich Patellar Instability score has been implemented to overcome the weakness of the Kujala score [35] and it is recommended for use in future studies [12]. In addition, Bitar et al concluded that the Kujala score was significantly increased by MPFL reconstruction [25].…”

“…Therefore, surgical treatment is gradually gaining the attention of clinicians [8]. MPFL and its reconstruction have been considered as the greatest advance in the therapy of lateral patellar dislocation in the past decade [12], and achieve satisfactory outcomes such as a low recurrent dislocation rate [13]. Although reconstructive surgery has many advantages, it is also associated with patellar fracture, postoperative stiffness, medial knee pain, and failed reconstruction [14].…”