It is once again my great pleasure to serve as Guest Editor for the Patellofemoral Instability issue of Sports Medicine and Arthroscopy Review. Much in the world has changed in the 10 years since we published Volume 15, Issue 2, in June of 2007. Navigating the clinical spectrum of patellofemoral disorders still remains one of the greatest challenges facing sports medicine specialists. Although the majority of patellofemoral problems are successfully treated nonoperatively, a subset of patients with recurrent patellar instability who undergo stabilization surgery are among our most grateful patients. The articles in this issue were written specifically to assist clinicians in helping those patients.
Although anatomy is timeless, our interpretation of the relationship between structures evolves as we change our perspective on how we look at anatomic structures. In the first paper, Tanaka demonstrates through careful dissection that the “medial patellofemoral ligament” may be more accurately described as “medial patellofemoral complex” as the proximal fibers often attach directly to the quadriceps tendon. Subsequent authors describe technological advances in computational analysis and imaging that have led to improved understanding of the multitude of anatomic and physiologic factors contributing to instability. The subtleties of the clinical examination remain a challenge for clinicians who evaluate the wide range of athletes and nonathletes of all ages who present with diverse clinical pictures. Dixit and Deu describe how nonoperative treatment remains appropriate for the majority of first-time dislocators. D’Amore and colleagues offer their recommendations on when, where, and how far to move the tibial tuberosity in patients with instability and malalignment. In their paper on complications of tibial tuberosity osteotomy, Johnson and colleagues review the potential for adverse outcomes and offer insight into how to prevent hardware and bone-healing complications.
Interest in trochlear osteotomy has gradually increased in the United States in the last 10 years. The paper by Diduch’s group describes indications for this procedure that will help the reader consider this relatively rare approach to stabilization in athletes with severe trochlear dysplasia. We are most fortunate to have a paper by Andrish on treatment for skeletally immature patients, an update from the paper he wrote in this journal 10 years ago. No issue committed to a surgical topic is complete without a paper dedicated to postoperative rehabilitation, as every experienced surgeon knows that a good surgical effort can lead to an excellent surgical result in the hands of an outstanding physical therapist.
I am greatly appreciative of the efforts of the students, physicians, therapists, and engineers who committed their time and energy to make this outstanding issue possible. I would like to take this opportunity to thank the editors of this journal, Ken DeHaven, Dilworth Cannon, and Greg Fanelli, for their longstanding commitment and leadership.