2022 Specialty Day Access Pass-Session III: Patellofemoral

Video Transcription

Video Summary

The session reviewed evolving strategies for treating patellar instability by balancing anatomic risk factors with individualized patient variables. Classic risk factors for recurrent dislocation include trochlear dysplasia, patella alta, lateral tilt, and excessive tibial tubercle lateralization (TT–TG). Although the “menu à la carte” approach historically corrected each factor with low recurrence, modern practice centers on MPFL/medial patellofemoral complex (MPFC) reconstruction, raising questions about which bony corrections are still necessary and at what thresholds.<br /><br />Speakers emphasized that measurements are not absolute: TT–TG can be elevated from true tubercle lateralization, femorotibial rotation, or medialized trochlear sulcus in high-grade dysplasia. Patellar height metrics can be misleading with abnormal patellar morphology; MRI-based patella–trochlear overlap and qualitative signs (e.g., “empty sulcus”) may better guide distalization decisions. Dynamic contributors—valgus, torsion, and faulty movement patterns (functional valgus, poor squat mechanics, hyperextension)—should be assessed and rehabilitated preoperatively.<br /><br />MPFC anatomy is variable (patellar and/or quadriceps attachments), allowing MPFL vs MQTFL-style reconstructions; accurate femoral tunnel placement and avoiding overtensioning are critical, and patellar fracture risk increases with large/transverse tunnels and anterior cortex violation.<br /><br />Tibial tubercle osteotomy (TTO) is added for malalignment/alta (instability) and for overload/cartilage injury (pain), with technique choices (medialization, anteromedialization, distalization) and nonunion prevention pearls. Trochleoplasty is reserved for severe dysplasia with convexity and substantial supratrochlear spur, often with a “jumping J sign,” and typically combined with MPFL reconstruction. Case discussions highlighted staging/soft-tissue-first in skeletally immature patients and lower thresholds for bony work when multiple borderline risks, laxity, or hyperextension coexist.

Asset Caption

Moderators: Cory Edgar, M.D., Ph.D., Jocelyn R. Wittstein, M.D.

Keywords

patellar instability

MPFL/MPFC reconstruction

trochlear dysplasia

tibial tubercle–trochlear groove distance (TT–TG)

patella alta

tibial tubercle osteotomy (TTO)

trochleoplasty

dynamic valgus and torsional malalignment