Different Modalities in Management of Recurrent Patellar Dislocation

Abstract

Patellar instability is a complex pathoanatomical phenomenon that requires an intricate understanding in order to properly treat patients. Often, the etiology of this entity is multifactorial, and can be the result of a combination of coronal limb malalignment, patella alta, malrotation secondary to internal femoral or external tibial torsion, a dysplastic trochlea, or disrupted and weakened medial soft tissue, including the medial patellofemoral ligament (MPFL) and the vastus medialis obliquus. The patella is positioned within a soft-tissue sleeve that extends from the anterior iliac spines of the pelvis and proximal femur to the tibial tubercle. Over the last 30° of knee extension, the patella lies outside the bony limits of the femoral trochlea, becoming more dependent on soft-tissue constraints. Recently, MPFL reconstruction has become a popular treatment option for recurrent lateral patellar dislocations, as this ligament is the primary passive restraint to lateral patellar translation of early knee flexion. The MPFL is often damaged during patellar subluxation or dislocation, and many different MPFL surgical reconstruction or repair techniques have been described in the literatures. MPFL reconstruction is safe to perform in patients with acute patellar dislocation and