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Patellofemoral Instability: Evaluation and Management

Department of Orthopaedics, Duke University Medical Center, Durham, NC, at the time of this writing.

Patellofemoral disorders are a common cause of knee pain and disability. A thorough history and a careful physical examination are essential to accurate diagnosis, and imaging modalities play an important role. Magnetic resonance imaging can provide information on malalignment and soft-tissue injuries. Although there is a continuum of diagnoses, most patellofemoral disorders can be divided into three distinct categories: soft-tissue abnormalities, patellar instability due to subluxation and dislocation, and patellofemoral arthritis. Many patellofemoral disorders respond to nonoperative therapy. When surgical intervention is necessary, patellar tilt can be successfully treated by a lateral release. Lateral patellar subluxation associated with malalignment can be corrected by a distal realignment procedure such as the anteromedial tibial tubercle transfer. Repair of the medial patellofemoral ligament in cases of patellar dislocation has considerably lowered the incidence of recurrent instability. Although no ideal treatment exists for patellofemoral arthritis, mechanical symptoms may be alleviated by arthroscopic debridement of delamination lesions. Articular cartilage-wear disorders may be stabilized by addressing the primary causative disorder.