AANA24 Knee All-Access Pass-CONCURRENT SCIENTIFIC SESSION 4B: Knee: Patellofemoral

Video Transcription

Video Summary

The session focused on patellar instability, covering clinical evaluation, treatment options, cartilage management, surgical failures, and new research findings. Dr. Bettina Henkel emphasized comprehensive physical exams and imaging to identify underlying causes of instability, such as malalignment, maltracking, hyperlaxity, patellar height, and trochlear dysplasia. She highlighted key diagnostic tests like the J-sign and patellar apprehension and advocated for a stepwise treatment approach from soft tissue procedures to osteotomies and trochleoplasties, tailored to individual deformities.<br /><br />Dr. Tanaka discussed surgical treatments, stressing individualized plans addressing soft tissue deficiencies (primarily MPFL/MQTFL reconstruction) and bony malalignment, including tibial tuberosity osteotomies to medialize, distalize, or anteriorize as needed. He stressed that MPFL reconstruction alone is insufficient when significant malalignment exists and outlined criteria for when trochleoplasty or osteotomies are warranted, also noting associated risks.<br /><br />Dr. Strickland focused on managing cartilage injuries in unstable knees, underscoring that significant cartilage damage often necessitates surgery and that malalignment must be corrected for cartilage repair success. Various cartilage restoration options were reviewed, including fixation of fragments, particulated juvenile cartilage, MACI, and osteochondral allografts, with their pros, cons, and limited long-term data discussed.<br /><br />Dr. Edgar shared insights on managing failed patellar instability surgeries, identifying common complications like persistent instability from under-treatment or technical errors. He highlighted the importance of thorough preoperative assessment, proper surgical technique, and patient-specific treatment to avoid failures and complications.<br /><br />A research presentation by Dr. Tanaka revealed that femoral tunnel landmarks commonly used in MPFL reconstruction are located more posteriorly and distally in patients with patellar instability and trochlear dysplasia, suggesting adjustments in surgical technique.<br /><br />A clinical case discussion illustrated applying these principles in practice, emphasizing individualized decision-making balancing deformity severity, surgical risk, and functional goals.<br /><br />Overall, the session emphasized a personalized, anatomy-driven approach combining careful assessment with a spectrum of surgical options to optimize outcomes in patellar instability treatment.

Asset Caption

Introduction by Moderators: Miho J. Tanaka, M.D., Ph.D., Marc Tompkins, M.D.

Keywords

patellar instability

clinical evaluation

treatment options

cartilage management

surgical failures

physical examination

imaging techniques

MPFL reconstruction

tibial tuberosity osteotomy

trochleoplasty

cartilage restoration