Farr J. Editorial Commentary: What Is the Optimal Management of First and Recurrent Patellar Instability? Patellofemoral Instability Management Continues to Evolve.
Arthroscopy 2018;
34:3094-3097. [PMID:
30392692 DOI:
10.1016/j.arthro.2018.08.046]
[Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/29/2018] [Indexed: 02/02/2023]
Abstract
Patellar instability patients may present for evaluation after their first instability episode or after recurrent episodes. Current management differs for these 2 groups. The accepted "common denominator" of patellar instability is the medial patellofemoral ligament, or medial patellar restraints, to be more all-encompassing. These patients often have multiple contributing comorbidities (e.g., trochlear dysplasia, patellar alta, excessive lateral position of tibial tubercle). Historically, the recommended treatment for a first-time patellar dislocation was nonoperative because medial soft tissue repairs had not been proven more effective. Indications for primary repair of the medial patellar restraints are a single discrete tear identified on magnetic resonance imaging. In the case of recurrent patellar instability, medial patellofemoral ligament reconstruction, rather than repair/reef, has been the recommended approach. The keys to reconstruction remain: honor the anatomy and avoid overconstraint of the patella. For first time dislocation patients with trochlear dysplasia, patellar alta, and age <25 years, recurrent instability is common.
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