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[Chronic patellofemoral instability].
[trochlear dysplasia]
Chronic
patellofemoral
instability
may
lead
to
pain
and
early
osteoarthrosis
.
Recurrent
dislocations
of
the
patella
,
lateral
subluxation
and
chronic
dislocation
are
summarized
under
this
generic
term
.
There
are
five
different
factors
which
may
be
responsible
of
the
development
of
chronic
patellofemoral
instability
:
1
)
elongation
of
the
medial
patellofemoral
ligament
(
MPFL
)
,
2
)
patella
alta
,
3
)
increased
distance
between
tibial
tuberosity
and
trochlea
groove
(
TTTG
)
distance
,
4
)
trochlea
dysplasia
and
5
)
torsional
malalignment
.
To
rule
out
these
factors
clinical
examination
,
radiological
diagnostics
(
luxation
,
subluxation
in
the
Defilée
view
,
trochlea
morphology
,
patella
alta
)
and
magnetic
resonance
imaging
(
MRI
)
of
TTTG
distance
and
trochlea
morphology
are
crucial
.
The
indications
of
operative
treatment
are
chronic
pain
with
subluxation
,
chronic
dislocation
and
recurrent
dislocation
.
Currently
the
former
frequently
and
universally
used
lateral
release
is
only
indicated
in
cases
of
subluxation
and
positive
tilt
.
Biomechanical
studies
have
shown
that
a
lateral
release
will
otherwise
increase
patellofemoral
instability
.
The
choice
of
the
surgical
technique
depends
on
the
factors
underlying
patellofemoral
instability
,
the
conditions
of
growth
plate
and
cartilage
damage
.
Among
the
different
surgical
options
proximal
and
distal
realignment
procedures
are
differentiated
.
In
cases
of
MPFL
elongation
and
mild
passive
instability
a
medial
reefing
might
be
successful
.
In
cases
of
MPFL
elongation
,
high
passive
instability
up
to
30
°
of
flexion
(
with
or
without
trochlear
dysplasia
)
MPFL
reconstruction
may
be
the
treatment
of
choice
.
A
trochleoplasty
is
rarely
indicated
.
This
treatment
may
be
considered
in
cases
of
high
grade
trochlea
dysplasia
and
passive
instability
at
more
than
30
°
of
flexion
.
If
the
TTTG
distance
is
increased
(
>
20
mm
)
or
in
cases
of
patella
alta
distal
realignment
with
tibial
tubercle
transfer
should
be
considered
.
This
operation
might
also
be
useful
in
the
presence
of
lateral
cartilage
damage
as
an
anteromedialization
of
the
patella
.
Diseases
Validation
Diseases presenting
"chronic patellofemoral instability"
symptom
trochlear dysplasia
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