Patellar instability: bony procedures

Patellofemoral joint plays a critical role in the biomechanics of the knee, alteration of this delicate balance can be produced by patellar instability. This condition presents a multifactorial pathogenesis: both soft tissues and osteo-cartilaginous tissues contribute to patellofemoral tracking therefore alteration of one of these components leads to patellar instability. To present a review of the main bony procedures’ indications and outcomes currently performed for patellar instability, a literature review was conducted using PubMed and Medline. The following search terms were entered into the title, abstract, and keyword fields: “patellar instability AND bony procedures OR tibial tubercle osteotomy OR trochleoplasty OR derotation osteotomy OR patellar osteotomy.” The first three authors reviewed 750 results, of which 76 articles were included in the analysis. Only articles in English with full-text availability were included in the research. Relevant studies were selected and analyzed to extract the most recent data. Main bony procedures’ indications and outcomes currently performed will be presented: tuberosity osteotomies, trochleoplasty, derotation osteotomies and patellar osteotomies. In this article, as a result of a thorough review of the literature, osteo-cartilaginous alterations such as tibial tuberosity malalignment, trochlear or patellar dysplasia and lower limb torsional deformities will be analyzed clarifying their role in patellar instability and bony procedures performed to treat these conditions will be presented.