Background. Patellar instability is one of the most common pathologies of the musculoskeletal system, predominantly observed in physically active young individuals. It ranks third in the structure of knee joint injuries after anterior cruciate ligament and meniscal injuries. 
The aim of this review to present modern perspectives on the diagnosis, principles, and surgical treatment techniques for patients with patellar instability based on an analysis of the literature. 
Methods. Publications were searched in the PubMed/MedLine and eLIBRARY databases. A total of 112 foreign articles published between 1984 and 2023 and 12 domestic publications from 2011 to 2022 were found. During the analysis, 68 articles were selected, which had full texts or abstracts containing sufficient information on diagnostic methods, commonly used standard and modified surgical correction methods for patellar instability, and treatment protocols considering patient age structure, instability characteristics, and functional demands. 
Results. A qualitatively new stage in the reconstructive and restorative surgery of patellar instability is the in-depth examination of patients to determine the extent of damage to the medial retinaculum and the presence of dysplastic changes in anatomical structures that provide normal biomechanics of the knee extensor apparatus. A strictly individual approach to the selection of surgical treatment methods considering risk factors contributing to the development of chronic patellar instability becomes of particular importance. 
Conclusion. Precise restoration of the medial patellofemoral ligament, supplemented by the correction of identified dysplastic changes in anatomical formations of the knee joint area, allows for better functional outcomes in patients with acute and chronic patellar instability.

/pdf/current-concepts-in-diagnostics-and-treatment-of-patellar-2t2pzqdb.pdf

Current Concepts in Diagnostics and Treatment of Patellar Instability: Review

BACKGROUND: The high frequency and recurrence of chronic patellar instability and the lack of unified treatment techniques indicate the need for a comprehensive individualized approach in the diagnosis and surgical treatment of patellar instability. 
AIM: To develop an algorithm and compare the anatomical and functional results of its use with those of traditional surgical treatment of patients with patellar instability. 
MATERIALS AND METHODS: The functional results of the treatment of 194 patients with patellar instability were compared. Two groups of patients were formed. The surgical treatment techniques of the main group (n = 93) were based on the results of the preoperative examination, considering risk factors of instability development, established as a result of retrospective analysis of the control group (n = 101). The effectiveness of the algorithm was compared with the techniques of patellar stabilization used from 2010 to 2015. The Kujala, IKDC 2000, and Lysholm scales were used to assess the functional results of treatment. 
RESULTS: Surgical treatment of instability aims to eliminate risk factors such as anomalies of the extensor apparatus of the knee joint and to repair or reconstruct damaged structures. Plasty of the medial patellofemoral ligament is the method of choice for patellar stabilization. In the case of dysplastic changes in the patellofemoral joint, combinations of proximal and distal knee joint surgeries were performed. Rotational lower-limb deformities were treated by corrective derotational osteotomy of the femur. Trochleoplasty was performed in cases of type B or D femoral block dysplasia. Patients with stiff lateral patellar retention underwent lateral release or extension tenotomy. In both groups, the functional status of the patients significantly (p 0.05) improved 12 months postoperatively. The mean values of the functional scales increased because of the increased number of patients with excellent and good scores in the group. Higher values were recorded in the main group (Kujala, p = 0.038; IKDC 2000, p = 0.021; Lysholm, p = 0.032). Patellar dislocation recurred in 2 (1.9%) patients in the control group (p = 0.172). 
CONCLUSIONS: The proposed algorithm helped verify the degree, type, and etiology of patellar instability and helped obtain better anatomofunctional treatment results in patients.

Improving surgical treatment of patients with patellar instability

Mit zunehmender Verbreitung der Rekonstruktion des medialen patellofemoralen Ligaments (MPFL) zur Behandlung der patellofemoralen Instabilitat steigt auch die Anzahl der Revisionsoperationen. Aufgrund der Komplexitat der Pathologie und mit zunehmendem Wissen uber die Biomechanik des patellofemoralen Gelenks zeigt sich, dass die Hauptfehlerquellen nach fehlgeschlagener MPFL-Rekonstruktion die Indikationsstellung und operationstechnische Fehler sind. Ziel des Artikels ist, Fehler in der Indikationsstellung sowie intraoperative Fehlerquellen exemplarisch darzustellen und Losungsmoglichkeiten aufzuzeigen. In diesem Beitrag soll diese Thematik aufgegriffen und auf Basis der Literatur und eigenen Beobachtungen diskutiert werden. Im Rahmen der Indikationsstellung wird haufig die zugrunde liegende Pathologie nicht adaquat analysiert und somit auch nicht adressiert. So kann sich bei Problemen nach MPFL-Rekonstruktion haufig das Vorliegen einer nicht adressierten hohergradigen Trochleadysplasie oder ausgepragten knochernen Valgus- und Rotationsdeformitat zeigen. Im Vordergrund stehen jedoch technische Operationsfehler, insbesondere die zu weit proximale bzw. ventrale femorale Transplantatverankerung. Dies kann zu einer vermehrten Druckbelastung des patellofemoralen Knorpels und somit zu einer progredienten Schadigung mit Arthroseentwicklung fuhren. Die MPFL-Rekonstruktion ist eine effektive Methode zur Behandlung der patellofemoralen Instabilitat. Nach fehlgeschlagener MPFL-Rekonstruktion ist die Indikationsstellung und somit die zugrundeliegende Pathologie genau zu analysieren. Signifikante Kopathologien sollten zusatzlich adressiert werden (u. a. Trochleaplastik, Valgus- und Rotationskorrektur). Bei operationstechnischen Fehlern sind individuelle Losungsstrategien, wie z. B. partielles Release, MPFL-Reinsertion, MPFL-Revisionsersatz u. a. erforderlich. Die femorale Transplantatinsertion sollte grundsatzlich intraoperativ rontgenologisch kontrolliert werden (Bildwandler). Samtliche Masnahmen sollten darauf abzielen, die physiologische Anatomie wiederherzustellen und die patellofemorale Druckbelastung zu minimieren.

Revisionen nach MPFL-Rekonstruktion

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Revisionen nach MPFL-Rekonstruktion