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Online ISSN 1827-1707
Philippe M. TSCHOLL , Victoria B. DUTHON
Department of Orthopedic Surgery, University Hospital of Geneva, Geneva, Switzerland
Detailed knowledge about clinical exam and imaging diagnostics is indispensable in recurrent patellar dislocation. Although in most patients conservative measures are the first treatment, surgical stabilization is inevitable usually when two or more patellar dislocations have occurred before the age of 16-20 years. It is however essential to depict the patients at risk for recurrent instability to prevent cartilaginous damage that might occur at any further incidence. Diagnostic tools are published in literature, however not yet established. Various surgical techniques isolated or in combination have been published in literature, such as medial patellofemoral ligament (MPFL)-reconstruction, medializing, distalizing or also anteromedializing tibial tubercle osteotomy, and several trochleoplasties with good to very good clinical results. In general, patellar stabilization is successful (>90-95%), regardless which technique is used with a higher risk of failures for all techniques in high-grade trochlear dysplasia. Pre-operative disregards of poor muscle control, malrotation or severe limb malalignment might be the cause of these failures, and might require more invasive surgical techniques such as de-rotational osteotomy. Pain management is much less predictable, and persisting pain in 30% of the patients is described in literature. Therefore, patients with patellofemoral pain and instability are at risk for less satisfactory postoperative result. Several algorithms have been published in literature, not yet showing any superiority. Our preferred approach is performing MPFL-reconstruction combined with tibial-tubercle osteotomy if necessary. Only in knees with a major supratrochlear bump or massive rotational malalignment, trochleoplasty or derotational osteotomy is performed. Indication for lateral release has become rare.