All Things Patellofemoral: Cartilage, Trochleoplasty and More (2024 Annual Meeting)-All Things Patellofemoral: Cartilage, Trochleoplasty and More

Video Transcription

Video Summary

This comprehensive lecture series on patellofemoral instability, moderated by Dr. Mio Tanaka, covered key topics including anatomy, surgical reconstruction techniques, realignment procedures, trochleoplasty, and cartilage management. Patellar instability commonly affects adolescents, especially females in pivoting sports, arising from complex multifactorial causes: soft tissue restraints, bony malalignment, and joint articulation changes.<br /><br />Dr. Tanaka detailed the medial patellofemoral complex (MPFC), emphasizing the medial patellofemoral ligament (MPFL) and the medial quadriceps tendon femoral ligament (MQTFL) as parts of a single ligament complex. Surgical reconstruction requires precise femoral tunnel positioning to avoid complications, with emphasis on avoiding patellar fractures and over-tightening. She advocated individualized treatment addressing both soft tissue and bony factors.<br /><br />Dr. Bettina Hinkle focused on distal realignment, examining coronal and rotational leg alignment, extensor mechanism alignment, and patellar height. She highlighted thorough physical exam and imaging to identify malalignment and the role of tibial tubercle osteotomy (TTO) in correcting alignment, stressing surgical technique refinements to reduce complications.<br /><br />Dr. Seth Sherman addressed trochleoplasty, underscoring trochlear dysplasia as a major instability and arthritis risk factor. He advocated cautious patient selection for trochleoplasty, favoring it mainly in severe cases with failed prior surgery, distinct J-signs, and prominent bony deformities, and shared evolving surgical strategies.<br /><br />Dr. Sabrina Strickland discussed cartilage injury management in patellofemoral instability. She emphasized thorough MRI evaluation, avoiding microfracture, preferring options such as cartilage repair, MACI, and osteochondral allografts, tailored to lesion size and patient needs. She highlighted complex cartilage restoration challenges and presented clinical cases illustrating tailored surgical approaches.<br /><br />Overall, the course stressed a multimodal, anatomy-driven, and patient-specific approach to patellofemoral instability incorporating soft tissue reconstruction, bony realignment, consideration of trochlear morphology, and cartilage preservation for optimal outcomes.

Asset Caption

Miho J. Tanaka, M.D., Ph.D., Moderator | Seth L. Sherman, M.D. | Sabrina M. Strickland, M.D. | Betina Hinckel, M.D., Ph.D.

Keywords

patellofemoral instability

medial patellofemoral complex

MPFL

MQTFL

surgical reconstruction

distal realignment

tibial tubercle osteotomy

trochleoplasty

trochlear dysplasia

cartilage management

patient-specific treatment