Functional testing and return to sport following stabilization surgery for recurrent lateral patellar instability in competitive athletes

Osteotomy of the Tibial Tubercle for Anteromedialization

Patellofemoral instability is a common cause of anterior knee pain, especially in younger and more active patients. Treatment of instability varies considerably depending on the patient's symptoms as well as the cause of the instability. Lateral instability has a particularly broad spectrum of treatment algorithms including patellar taping, arthroscopy, lateral release, medial patellofemoral ligament (MPFL) reconstruction, MPFL repair, and osteotomy of the tibial tubercle for realignment. Acute traumatic lateral dislocation is commonly associated with a tear of the MPFL and, therefore, needs to be addressed. However, patients who show lateralization of the tibial tubercle with an increased tibial tubercle-to-trochlear groove distance, tibial tubercle-to-posterior cruciate ligament distance, and Q-angle measurements often display chronic instability even after an MPFL reconstruction. In these cases, an osteotomy of the tibial tubercle is required to establish proper alignment and minimize the risk of recurrence of instability. The objective of this Technical Note is to describe our preferred method to complete a Fulkerson tibial tubercle osteotomy for anteromedialization and treatment of chronic patellar instability.

Current Concepts in the Management of Patellar Instability

Patellar instability is a common presenting clinical entity in the field of orthopedics. This not only can occur from baseline morphologic variability within the patellofemoral articulation and alignment, but also from traumatic injury. While conservative management is many times employed early in the treatment course, symptomatic patellar instability can persist. This article reviews the available indexed published literature regarding patellar instability. Given the debilitating nature of this condition and the long term sequelae that can evolve from its lack of adequate recognition and treatment, this article details the most current methods in the evaluation of this entity as well as reviews the most up-to-date surgical treatment regimens that are available to address this condition.