AANA Lab Course 910 - Patellofemoral Joint Preservation-Recurrent Patella Instability – What to Choose and When-Dr. Marc Tompkins, M.D.

Recurrent Patella Instability – What to Choose and When-Dr. Marc Tompkins, M.D.

Pdf Summary

This presentation by Dr. Marc Tompkins focuses on recurrent patellofemoral instability, outlining anatomy, diagnostic approaches, surgical considerations, and perioperative care. Patellofemoral instability involves abnormal patellar motion—medial/lateral translation, tilt, spin, and flexion—controlled by dynamic stabilizers like quadriceps muscles, patellar tendon, and medial/lateral ligaments.<br /><br />Key anatomic risk factors are highlighted: patella alta (high-riding patella), trochlear dysplasia (poor trochlear groove formation), extensor malalignment (including increased tibial tubercle–trochlear groove [TTTG] distance), valgus alignment, rotational malalignment (femoral anteversion, tibial torsion), patellar tilt from lateral retinaculum tightness, and medial patellofemoral ligament (MPFL) insufficiency. Each factor affects patellar tracking and stability and guides treatment choice.<br /><br />Surgical options include tibial tubercle distalization or anteromedialization to address patella alta and extensor malalignment, trochleoplasty for severe trochlear dysplasia (not generally for skeletally immature patients), lateral retinacular lengthening for patellar tilt, MPFL reconstruction for medial ligament insufficiency, and osteotomy for correcting valgus deformity.<br /><br />The overall surgical goal is to restore patellar tracking and guidance into the trochlear groove without forcibly pulling the patella.<br /><br />Perioperative planning requires preoperative physical therapy and primary care evaluations, considering surgery invasiveness and recovery duration that may necessitate overnight stays and prolonged follow-up for up to a year.<br /><br />Patient education and partnership are emphasized as critical, with physical therapy and nonoperative modalities key to both preoperative assessment and postoperative rehabilitation. Understanding the lengthy recovery process by the patient and their support system ensures improved outcomes.

Keywords

recurrent patellofemoral instability

patella alta

trochlear dysplasia

extensor malalignment

medial patellofemoral ligament insufficiency

tibial tubercle osteotomy

trochleoplasty

lateral retinacular lengthening

perioperative care

postoperative rehabilitation