Current Concepts Regarding Patellofemoral Trochlear Dysplasia

Optimal treatment of patients with patellofemoral trochlear dysplasia and recurrent patellar instability requires in-depth understanding of this complex structural anomaly. An extensive review of the literature suggests that dysplasia occurs as a result of aberrant forces applied to the patellofemoral joint in the majority of cases. Evidence supports surgical stabilization that reconstructs the medial patellofemoral and/or medial quadriceps tendon–femoral ligament without added trochleoplasty in the majority of patients with trochlear dysplasia and recurrent patellar instability. Adding tibial tubercle transfer distally, medially, or anteromedially in those who need it to treat specific deficits in alignment or articular cartilage can be beneficial in selected patients with trochlear dysplasia and recurrent patellar instability. Trochleoplasty may be appropriate in those few cases in which permanent stable patellofemoral tracking cannot be restored otherwise, but the indications are not yet clear, particularly as trochleoplasty adds risk to the articular cartilage. Improved understanding of imaging techniques and 3-dimensional reproductions of dysplastic patellofemoral joints are useful in surgical planning for patients with recurrent patellar instability and trochlear dysplasia.