Management of Patellofemoral Instability: Stabilization, Cartilage Restoration, Resurfacing, and Arthroplasty (AANA19)-Instructional Course Lecture_ Management of Patellofemoral Instability_ Stabilization, Cartilage Restoration, Resurfacing, and Arthroplasty-Dr. Andreas H. Gomoll, M.D.

Instructional Course Lecture_ Management of Patellofemoral Instability_ Stabilization, Cartilage Restoration, Resurfacing, and Arthroplasty-Dr. Andreas H. Gomoll, M.D.

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Video Transcription

Video Summary

This detailed lecture covers surgical approaches for patellar instability, focusing primarily on tibial tubercle osteotomy (TTO) and distal femoral osteotomy (DFO). Patellar instability is multifactorial, influenced by factors such as traumatic events, ligamentous laxity, trochlear dysplasia, femoral rotation, valgus alignment, patella alta, and increased tibial tubercle–trochlear groove distance (TTTG). Traditionally, surgery was reserved for recurrent dislocations, but emerging evidence suggests earlier intervention for high-risk patients. Evaluation involves clinical assessment (e.g., J sign, ligamentous laxity) and imaging (X-rays and MRI) to assess alignment, chondral defects, and rotational abnormalities. DFO addresses valgus malalignment or femoral anteversion, while TTO corrects lateralization and patella alta. TTO techniques include medialization, anteriorization, and distalization, with the latter requiring careful surgical technique and bone grafting to avoid complications. Both procedures have shown positive outcomes in reducing recurrent instability and improving tracking. Overall, individualized assessment and surgical planning are critical for effective management of patellar instability.

Asset Caption

Instructional Course Lecture: Management of Patellofemoral Instability: Stabilization, Cartilage Restoration, Resurfacing, and Arthroplasty

Keywords

patellar instability

tibial tubercle osteotomy

distal femoral osteotomy

valgus malalignment

patella alta

TTTG distance