The Evolution of Patellofemoral Instability Surgery

Background: Patellar instability is a common knee condition characterized by recurrent dislocations of the patella, often leading to significant pain and functional limitations. Over the past ۲۵ years, the understanding of its pathophysiology has evolved, highlighting the importance of anatomic factors such as trochlear dysplasia, patellar height, and the integrity of the medial patellofemoral ligament (MPFL). This evolution has influenced surgical approaches, shifting from traditional techniques to more anatomy-focused methods aimed at restoring stability and minimizing complications. Methods: This study examines the trends in surgical interventions for patellar instability from ۱۹۹۷ to ۲۰۱۶, analyzing data from multiple studies to assess the effectiveness and incidence of various surgical techniques. The review includes a range of methods, such as MPFL reconstruction, distal tibial tubercle transfer, and femoral osteotomy. The analysis focuses on patient demographics, types of surgeries performed, and measured outcomes through clinical scores like the Kujala and Lysholm scores. This study also explores the rising popularity of ligament reconstruction methods compared to other techniques during the specified period. Results: A total of ۹,۷۰۲ surgeries for patellar dislocation were performed during the study period, with an average patient age of ۲۳ years. The overall incidence of surgeries remained stable at ۸.۹ per ۱۰۰,۰۰۰ individuals per year. Notably, ligament reconstruction methods experienced a significant increase in frequency after ۲۰۰۹, surpassing debridement operations by ۲۰۱۵. MPFL reconstruction emerged as the gold standard for treating patellar instability due to its effectiveness in reducing recurrence rates. However, variations in functional outcomes among different surgical techniques were observed, indicating that while MPFL reconstruction is effective for many patients, individualized treatment plans based on specific anatomical considerations are essential for optimal results. Conclusion: The evolution of surgical techniques for femoral patellar instability over the past ۲۵ years reflects significant advancements in understanding the anatomic aspects of the condition. Current practices favor an appropriate approach that considers patient anatomy and recurrence risk factors. As research continues to refine these techniques and improve outcomes, adopting a stratified risk approach for surgical intervention is crucial, particularly for high-risk populations such as young patients with trochlear dysplasia. The ongoing development of minimally invasive techniques also promises improved recovery times and outcomes.

کلیدواژه ها:

Patellofemoral instability ، Surgical evolution ، MPFL reconstruction ، Knee surgery ، Recurrent dislocation