Editorial Commentary: What Is the Optimal Management of First and Recurrent Patellar Instability? Patellofemoral Instability Management Continues to EvolveN

[摘要] Patellar instability patients may present for evaluation after their first instability episode or after recurrent episodes. Current management differs for these 2 groups. The accepted common denominator of patellar instability is the medial patellofemoral ligament, or medial patellar restraints, to be more all-encompassing. These patients often have multiple contributing comorbidities (e.g., trochlear dysplasia, patellar alta, excessive lateral position of tibial tubercle). Historically, the recommended treatment for a first-time patellar dislocation was nonoperative because medial soft tissue repairs had not been proven more effective. Indications for primary repair of the medial patellar restraints are a single discrete tear identified on magnetic resonance imaging. In the case of recurrent patellar instability, medial patellofemoral ligament reconstruction, rather than repair/reef, has been the recommended approach. The keys to reconstruction remain: honor the anatomy and avoid overconstraint of the patella. For first time dislocation patients with trochlear dysplasia, patellar alta, and age <25 years, recurrent instability is common.

[发布日期] 2018-11-01