• ➤ Patellar instability represents a common problem with an evolving understanding and multifactorial pathoetiology. Treatment plans should be based on the identification of contributing anatomical factors and tailored to each individual patient.
• ➤ Risks for recurrent instability are dependent on several patient-specific factors including patella alta, increased tibial tubercle-to-trochlear groove (TT-TG) distance, trochlear dysplasia, younger skeletal age, and ligamentous laxity.
• ➤ Cartilage or osteochondral lesions and/or fractures are commonly observed in first-time patellar dislocation, and magnetic resonance imaging (MRI) should be strongly considered. Advanced imaging modalities, such as computed tomography (CT) or MRI, should also be obtained preoperatively to identify predisposing factors and guide surgical treatment.
• ➤ Medial patellofemoral ligament (MPFL) reconstruction with anatomical femoral tunnel positioning is associated with lower recurrence rates compared with MPFL repair and has become a common and successful reconstructive surgical option in cases of instability.
• ➤ Lateral retinacular tightness can be addressed with lateral retinacular release or lengthening, but these procedures should not be performed in isolation.
• ➤ Tibial tubercle osteotomy is a powerful reconstructive tool in the setting of underlying skeletal risk factors for instability and can be of particular benefit in the presence of increased TT-TG distance (>20 mm), and/or in the setting of patella alta.
• ➤ The indications for trochleoplasty are still developing along with the clinical evidence, but trochleoplasty may be indicated in some cases of severe trochlear dysplasia. Several surgical techniques have indications in specific clinical scenarios and populations, and indications, risks, and benefits to each are progressing with our understanding.
• ➤ Combined femoral derotational osteotomy and MPFL reconstruction can be considered for patients with a femoral anteversion angle of >30° to improve patient outcomes and reduce recurrence rates.

中文翻译：

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髌骨外侧不稳定

• ➤ 髌骨不稳定是一个常见问题，其认识不断发展，病理学也涉及多因素。治疗计划应基于确定影响解剖学因素并针对每个患者量身定制。
• ➤ 复发不稳定的风险取决于多个患者特定因素，包括高位髌骨、胫骨结节至滑车沟 (TT-TG) 距离增加、滑车发育不良、骨龄较年轻和韧带松弛。
• ➤ 软骨或骨软骨损伤和/或骨折常见于首次髌骨脱位，应强烈考虑磁共振成像 (MRI)。术前还应获得先进的成像方式，例如计算机断层扫描 (CT) 或 MRI，以识别诱发因素并指导手术治疗。
• ➤ 与 MPFL 修复相比，采用解剖股骨隧道定位的内侧髌股韧带 (MPFL) 重建具有较低的复发率，并且已成为不稳定情况下常见且成功的重建手术选择。
• ➤ 外侧支持带紧张可以通过外侧支持带松解或延长来解决，但这些手术不应单独进行。
• ➤ 胫骨结节截骨术是一种强大的重建工具，适用于存在潜在骨骼不稳定风险因素的情况，并且在 TT-TG 距离增加（> 20 毫米）和/或高髌骨的情况下尤其有益。
• ➤ 滑车成形术的适应症仍在随着临床证据的发展而不断发展，但在某些严重滑车发育不良的病例中可能需要进行滑车成形术。几种手术技术在特定的临床情况和人群中都有适应症，并且每种手术技术的适应症、风险和益处都在随着我们的理解而不断进展。
• ➤ 对于股骨前倾角>30°的患者，可考虑联合股骨去旋转截骨术和MPFL重建，以改善患者预后并降低复发率。