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Farr, Jack II MD*,†; Tanaka, Miho J. MD‡,§

Sports Medicine and Arthroscopy Review: December 2019 - Volume 27 - Issue 4 - p 129
doi: 10.1097/JSA.0000000000000264

*Knee Preservation and Cartilage Research Center, OrthoIndy Hospital, Greenwood

Department of Orthopaedic Surgery, Indiana University Medical Center, Indianapolis, IN

Women’s Sports Medicine Program, Massachusetts General Hospital

§Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA

Disclosure: The authors declare no conflict of interest.

Reprints: Jack Farr II, MD, Knee Preservation and Cartilage Research Center, OrthoIndy Hospital, Greenwood, IN 46143.

We are pleased to present this issue on Patellofemoral Instability as guest editors for Sports Medicine and Arthroscopy Review. While the field of patellofemoral surgery becomes more and more sophisticated, the topics in this issue bring us back to the basics of how, when, and why we consider each component of the surgical management of patellofemoral disorders.

Krych and Dahm begin by providing a detailed overview of the treatment of first-time patellar dislocations and remind us that, while many cases are treated conservatively, the assessment and understanding of risk factors are important considerations in determining the treatment course. As medial patellar anatomy has recently been brought back into focus, Chahla and Fulkerson review the concept of the Proximal Medial Patellar Restraints that consist of the traditional medial patellofemoral ligament and medial quadriceps tendon femoral ligament, while Hinckel and Arendt focus on the Distal Medial Patellar Restraints, which include the medial patellotibial ligament and medial patellomeniscal ligament. And, as our understanding of the differential roles of these fibers evolves, we discuss the implications for the reconstruction of the ribbon-shaped femoral origin of the proximal medial restraints.

As we well know, reconstruction of the medial restraints is an effective procedure for recreating patellar stability, but the multifactorial nature of this problem necessitates that we address the concurrent pathology that contributes to instability. Shubin Stein takes us through why and where to move the tibial tuberosity during distal realignment surgery, and Lattermann discusses when adding lateral soft tissue balancing can be helpful. Diduch provides his perspective on the addition of trochleoplasty to address the dysplastic trochlea. And, finally, Green and Parikh review and discuss how these techniques and concepts can vary in the pediatric management of recurrent patellar instability.

Throughout this issue, the authors have provided up-to-date references to highlight the latest concepts in the evolution of patellar instability surgery, while providing context and clinical guidance as to the key concepts that surgeons should consider as they treat this complex condition. We would like to thank the journal editors Drs. Cannon, Fanelli, and Barber for the opportunity to serve as guest editors for this issue. We would especially like to thank all of the authors who made this issue not only possible for us, but also enjoyable and educational, as we continue together in our pursuit of furthering our understanding of patellofemoral joint instability and its treatment.

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