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Patellofemoral Instability: Proximal Realignment and Trochleoplasty

  • Maureen Monda
  • Antony PalmerEmail author
Chapter

Abstract

Patellar instability is multifactorial. Proximal femoral derotation osteotomies and trochleoplasty allow direct correction of morphological abnormalities which produce instability and can be used alone or in combination with other procedures such a distal realignment or soft tissue procedures including medial patellofemoral ligament (MPFL) reconstruction or a lateral release. Where trochlear dysplasia, excessive femoral anteversion or torsion are not recognised and addressed, surgery to treat recurrent patella instability has worse outcomes. When clinical examination suggests abnormal trochlear morphology, version or torsion, cross-sectional imaging is indicated. Rotational osteotomies and trochleoplasty, has a robust and growing evidence base, and with careful planning and execution, both can be highly effective in treating recurrent instability. Proximal realignment procedures to the quadriceps are performed less frequently but may prove valuable in selected cases, in particular skeletally immature patients.

Keywords

Patellofemoral Instability Proximal realignment Trochleoplasty Results 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Joint Reconstruction UnitRoyal National Orthopaedic HospitalStanmoreUK
  2. 2.Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesUniversity of OxfordOxfordUK

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