2021 AOSSM-AANA Combined Annual Meeting Recordings-Patellar Instability

Video Transcription

Video Summary

In this video, Dr. Ed Wojtys discusses the challenges and considerations when treating athletes with patella instability. The medial patella femoral ligament (MPFL) is crucial in preventing patella dislocation, with studies showing it tears in 87% of dislocation cases. Deciding when to operate on patients with recurrent instability is a challenge because while surgery may be necessary, it can also come with risks such as permanent articular cartilage injuries. Non-operative treatment options that focus on quad strengthening and hip abductors and external rotators can be successful for some patients. Immobilization, in many cases, has no impact on the success of non-operative treatment and may cause loss of quad strength. Surgery, typically using a graft such as the gracilis, aims to restore the anatomy and has shown good outcomes in terms of return to sport and low rates of redislocation. Anatomic risk factors, such as patella alta, malalignment, valgus, and dysplasia, should be evaluated to determine if additional procedures, such as tibial tubercle osteotomy or distal femoral opening wedge osteotomy, are necessary. The key to success in surgery is the correct placement of the graft on the femur. Dr. Wojtys highlights the importance of identifying anatomic risk factors in decision-making and advises against relying solely on lateral release as a solution for patella instability.

Asset Caption

David Diduch, MD

Keywords

patella instability

medial patella femoral ligament

surgery risks

non-operative treatment options

anatomic risk factors