AANA25 Knee Access Pass-CONCURRENT SESSION 2C: Patellofemoral Problems

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Video Summary

This medical symposium focused on patellofemoral instability, exploring evaluation, treatment algorithms, surgical techniques, and outcomes, particularly among young and athletic patients. Key risk factors include trochlear dysplasia, patella alta, and extensor mechanism malalignment, with patient-specific factors such as activity level and laxity influencing treatment decisions. The evaluation emphasizes thorough physical exams, imaging (X-rays, MRI, CT, including dynamic assessments), and individualized risk scoring.<br /><br />One presentation highlighted a study comparing isolated medial patellofemoral ligament (MPFL) reconstruction versus MPFL plus tibial tubercle osteotomy (TTO) for recurrent instability. Results showed isolated MPFL patients returned to sport sooner (9 vs. 13 months) and at higher levels, though both groups had excellent long-term functional outcomes. Fear of re-injury (kinesiophobia) influenced delayed return in the TTO group, who had more significant cartilage damage and longer symptom duration.<br /><br />Another discussion covered osteochondral allografts for patellofemoral cartilage lesions in high-level athletes, reporting a 92% return to sport rate and sustained improvement over four years with low complication rates. Surgical technique refinements and graft matching were stressed for optimal results.<br /><br />Revision strategies emphasized comprehensive assessment of alignment, stability, and cartilage status, noting common pitfalls like malpositioned tunnels or over-tensioning soft tissues. Emphasis was on multidisciplinary and personalized approaches, including fiseal-sparing MPFL reconstructions for skeletally immature patients with open growth plates. Debate exists on timing and use of TTO and trochleoplasty, with considerations for growth and skeletal maturity.<br /><br />Advanced imaging and 3D modeling have improved diagnosis of trochlear dysplasia, aiding surgical planning. Challenges remain in defining clear algorithms and return-to-sport metrics, with a consensus that patellofemoral instability treatment is complex and must be tailored individually. Robust rehabilitation and addressing psychological factors are critical aspects to optimize patient outcomes.

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Keywords

patellofemoral instability

medial patellofemoral ligament reconstruction

tibial tubercle osteotomy

trochlear dysplasia

patella alta

extensor mechanism malalignment

osteochondral allografts

return to sport

kinesiophobia

skeletal maturity