Updates in the management of lateral patellar instability
Purpose: The purpose of this study was to review current concepts in the evaluation and management of lateral patellar instability, focusing on anatomical risk factors, diagnostic approaches, and treatment strategies. Methods: A comprehensive review of the literature examining anatomical considerati...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-06-01
|
| Series: | Journal of Joint Surgery and Research |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S294970512500009X |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849732071856013312 |
|---|---|
| author | Amber M. Parker Naofumi Hashiguchi Miho J. Tanaka |
| author_facet | Amber M. Parker Naofumi Hashiguchi Miho J. Tanaka |
| author_sort | Amber M. Parker |
| collection | DOAJ |
| description | Purpose: The purpose of this study was to review current concepts in the evaluation and management of lateral patellar instability, focusing on anatomical risk factors, diagnostic approaches, and treatment strategies. Methods: A comprehensive review of the literature examining anatomical considerations, risk factors, diagnostic methods, and treatment options for patellar instability was conducted. The review focused on the medial patellofemoral complex (MPFC) anatomy, various imaging modalities, and conservative and surgical management approaches. Results: Patellar instability involves multiple anatomical risk factors, including abnormalities in dynamic/static stabilizers, osseous restraints, and lower extremity alignment. The MPFC, consisting of the medial patellofemoral ligament (MPFL) and medial quadriceps tendon–femoral ligament, provides primary restraint against lateral instability in early knee flexion. While 94–100% of first-time dislocations involve MPFL injury and can be managed conservatively, patients with multiple risk factors show 70–90% recurrence rates. Surgical treatment through MPFC reconstruction shows low redislocation rates (1.8–4.5%) and may be combined with additional procedures such as tibial tubercle osteotomy, trochleoplasty, or alignment correction based on individual pathoanatomy. Conclusions: Successful management of patellar instability requires a comprehensive evaluation of anatomical risk factors and individualized treatment approaches. While conservative management is appropriate for first-time dislocations without significant risk factors, surgical intervention through MPFC reconstruction and associated procedures shows promising outcomes in preventing recurrence and improving function in high-risk patients. |
| format | Article |
| id | doaj-art-388b5e954f4c4a3581a37c93eb6fd32f |
| institution | DOAJ |
| issn | 2949-7051 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Joint Surgery and Research |
| spelling | doaj-art-388b5e954f4c4a3581a37c93eb6fd32f2025-08-20T03:08:21ZengElsevierJournal of Joint Surgery and Research2949-70512025-06-013210311210.1016/j.jjoisr.2025.04.001Updates in the management of lateral patellar instabilityAmber M. Parker0Naofumi Hashiguchi1Miho J. Tanaka2Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge St., Suite 400, Boston, MA 02114, USASports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, 175 Cambridge St., Boston, MA 02114, USADepartment of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge St., Suite 400, Boston, MA 02114, USA; Corresponding author.Purpose: The purpose of this study was to review current concepts in the evaluation and management of lateral patellar instability, focusing on anatomical risk factors, diagnostic approaches, and treatment strategies. Methods: A comprehensive review of the literature examining anatomical considerations, risk factors, diagnostic methods, and treatment options for patellar instability was conducted. The review focused on the medial patellofemoral complex (MPFC) anatomy, various imaging modalities, and conservative and surgical management approaches. Results: Patellar instability involves multiple anatomical risk factors, including abnormalities in dynamic/static stabilizers, osseous restraints, and lower extremity alignment. The MPFC, consisting of the medial patellofemoral ligament (MPFL) and medial quadriceps tendon–femoral ligament, provides primary restraint against lateral instability in early knee flexion. While 94–100% of first-time dislocations involve MPFL injury and can be managed conservatively, patients with multiple risk factors show 70–90% recurrence rates. Surgical treatment through MPFC reconstruction shows low redislocation rates (1.8–4.5%) and may be combined with additional procedures such as tibial tubercle osteotomy, trochleoplasty, or alignment correction based on individual pathoanatomy. Conclusions: Successful management of patellar instability requires a comprehensive evaluation of anatomical risk factors and individualized treatment approaches. While conservative management is appropriate for first-time dislocations without significant risk factors, surgical intervention through MPFC reconstruction and associated procedures shows promising outcomes in preventing recurrence and improving function in high-risk patients.http://www.sciencedirect.com/science/article/pii/S294970512500009XPatellar instabilityMedial patellofemoral ligamentMedial patellofemoral complexTrochlear dysplasiaPatella altaTibial tuberosity osteotomy |
| spellingShingle | Amber M. Parker Naofumi Hashiguchi Miho J. Tanaka Updates in the management of lateral patellar instability Journal of Joint Surgery and Research Patellar instability Medial patellofemoral ligament Medial patellofemoral complex Trochlear dysplasia Patella alta Tibial tuberosity osteotomy |
| title | Updates in the management of lateral patellar instability |
| title_full | Updates in the management of lateral patellar instability |
| title_fullStr | Updates in the management of lateral patellar instability |
| title_full_unstemmed | Updates in the management of lateral patellar instability |
| title_short | Updates in the management of lateral patellar instability |
| title_sort | updates in the management of lateral patellar instability |
| topic | Patellar instability Medial patellofemoral ligament Medial patellofemoral complex Trochlear dysplasia Patella alta Tibial tuberosity osteotomy |
| url | http://www.sciencedirect.com/science/article/pii/S294970512500009X |
| work_keys_str_mv | AT ambermparker updatesinthemanagementoflateralpatellarinstability AT naofumihashiguchi updatesinthemanagementoflateralpatellarinstability AT mihojtanaka updatesinthemanagementoflateralpatellarinstability |