Patella

The following chapter provides an overview of surgical interventions for addressing patellofemoral instability, associated with medial patellofemoral ligament (MPFL) reconstruction, repair of medial patellofemoral ligaments, trochleoplasty, lateral release and tibial tuberosity transfer. Since patellofemoral instability is determined by various soft tissue and bony structures, it is important to conduct a symptom-oriented medical history and precise clinical examination. Different radiological examinations such as X-ray of the knee joint in three views, long leg standing AP view, MRI and CT rotation analysis should be considered. MPFL reconstruction is indicated for symptomatic chronic patellofemoral instability without severe osseous deformities and initial patellar dislocations with risk factors. The technique involves utilizing an autologous tendon graft and direct screw fixation. Repair of medial patellofemoral ligaments is recommended for acute patellofemoral instability, particularly in young patients. The surgical approach includes the use of suture anchors. Emphasis is placed on reattaching the ruptured ligaments securely, ensuring proper repositioning of the patella. Trochleoplasty addresses chronic patellofemoral instability accompanied by severe trochlear dysplasia. The procedure aims to deepen and lateralize the trochlear groove facilitating physiological patellar tracking. An osteochondral flap is carefully elevated and reconfigured, followed by fixation using vicryl tapes. Tibial tuberosity transfer is indicated in patellofemoral instability with pathologically increased TTTG distance and Q-angle or patellofemoral hypercompression. Lateral release and retinaculum lengthening are performed in patellofemoral hypercompression without patellofemoral instability.