Patellofemoral Instability: Distal Realignment

  • Suroosh Madhanipour
  • Kostas Michail
  • Sam Oussedik


Distal realignment is one of the most well-established treatments for patellar instability, allowing treatment of risk factors including patella alta and increased tibial tubercle-trochlear groove (TT-TG) distance. Prior to performing a distal realignment, the surgeon needs to perform a comprehensive assessment of the patient including measurement of patellar height and alignment. Distal realignment is best employed if either of these is abnormal—if trochlear dysplasia or rotational abnormalities of the limb are present, other surgical interventions may be more appropriate. This chapter outlines the rationale for distal realignment, the regime of preoperative assessment and the surgical technique. Performed properly, for the correct indications, and in the absence of complications including fracture, iatrogenic patella baja and nonunion, distal realignment can achieve excellent results, with a long-term rate of recurrent instability of around 7% overall.


Patellofemoral Instability Distal realignment Surgical technique Outcomes Complications 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Suroosh Madhanipour
    • 1
  • Kostas Michail
    • 2
  • Sam Oussedik
    • 3
  1. 1.Department of Trauma and OrthopaedicsUniversity College London Hospitals NHS TrustLondonUK
  2. 2.Senior Knee FellowUniversity College London Hospitals NHS TrustLondonUK
  3. 3.Department of Orthopaedic SurgeonUniversity College London Hospitals NHS TrustLondonUK

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