Chronic Patellar Instability: Anatomic Precondition and Approaches to Surgical Treatment

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The literature review is dedicated to the problem of recurrent patella dislocation treatment. The key anatomic predispositions to patellar instability development are presented. The principles on which the techniques for surgical treatment of recurrent patella dislocation have been developed and used since the early 19th century are described. Thirty years’ experience in use of various surgical techniques for patellar stabilization that show both obvious advantages and certain disadvantages is generalized. Actual problems and issues of recurrent patella dislocation surgical treatment are reflected.

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About the authors

Aleksandr I. Avdeev

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

Resident St. Petersburg, Russia

I. A Kuznetsov

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

St. Petersburg, Russia

D. A Shulepov

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

St. Petersburg, Russia

M. R Salikhov

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

St. Petersburg, Russia


  1. Волоховский Н.Н. Оперативное лечение вывихов надколенника у взрослых: Автореф. дис. … канд. мед. наук. Санкт-Петербург; 2005.
  2. Hsiao M., Owens B.D., Burks R. Incidence of acute traumatic patellar dislocation among active-duty United States military service members. Am. J. Sports Med. 2010; 38 (10): 1997-2004. doi: 10.1177/0363546510371423.
  3. Fithian D.C., Paxton E.W., Stone M.L. Epidemiology and natural history of acute patellar dislocation. Am. J. Sports Med. 2004; 32 (5): 1114-21. doi: 10.1177/0363546503260788.
  4. Болотин Г.Д. Вывихи надколенника. Ортопедия, травматология и протезирование. 2010; (13): 91-5.
  5. Маланин Д.А., Новиков Д.А., Сучилин И.А., Черезов Л.Л. Роль внутренней бедренно-надколенниковой связки в обеспечении устойчивости надколенника: особенности анатомического строения и биомеханики. Травматология и ортопедия России. 2015; 2 (76): 56-65. doi: 10.21823/2311-2905-2015-0-2-56-65.
  6. Weber A.E., NathaniA., Joshua S.D. et al. An Algorithmic approach to the management of recurrent lateral patellar dislocation. J. Bone Joint Surg. Am. 2016; 98 (5): 417-27. doi: 10.2106/JBJS.O.00354.
  7. Гайворонский И.В. Нормальная анатомия человека. т. 1. СПб: СпецЛит; 2000.
  8. Grelsamer R.P., Klein J.R. The biomechanics of the patellofemoral joint. J. Orthop. Sports Phys. Ther. 1998; 28 (5): 286-98.
  9. Волков М.В., ред. Руководство по ортопедии и травматологии. т. 2. М.: Медицина; 1968: 644-65.
  10. Senavongse W., Amis A.A. The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability. J. Bone Joint Surg. Br. 2005; 87 (4): 577-82. doi: 10.1302/0301-620X.87B4.14768.
  11. Warren L.F., Marshall D.V.M. The supporting structures and layers on the medial side of the knee. J. Bone Joint Surg. Am. 1979; 61 (1): 56-62.
  12. Arendt E.A., Dejour D. Patella instability: building bridges across the ocean a historic review. Knee Surg. Traumatol. Arthrosc. 2013; 21 (2): 279-93. doi: 10.1007/ s00167-012-2274-1.
  13. Isermeyer H. On pathologic luxation of the patella. Arch. Klin. Chir. 1967; 8: 1-23.
  14. Baumgartl F. Anatomische und klinische Bedeutung des Femoropatellargelenkes. Zentralbl. Chir. 1966; 14: 505-16.
  15. Wiberg G. Roentgenographic and anatomic studies on the femoropatellar joint with special reference to chondromalacia patellae. Acta Orthop. Scand. 1941; 12: 319-410.
  16. Tecklenburg K., Dejour D., Hoser C., Fink C. Bony and cartilaginous anatomy of the patellofemoral joint. Knee Surg. Sports Traumatol. Arthrosc. 2006; 14 (3): 235-40. doi: 10.1007/s00167-005-0683-0.
  17. Blumensaat C. Die lageabweichungen and verrenkungen der kniescheibe. Ergeb. Chir Orthop. 1938; 31: 149-223.
  18. Insall J., Salvati E. Patella position in the normal knee joint. Radiology. 1971; 101 (1): 101-4. doi: 10.1148/101.1.101.
  19. Blackburne J.S., Peel T.E. A new method of measuring patellar height. J. Bone Joint Surg. Br. 1977; 59 (2): 241-2.
  20. Caton J. Method of measuring the height of the patella. Acta Orthop. Belg. 1989; 55 (3): 385-6 (in French).
  21. Brattstrom H. Shape of the intercondylar groove normally and in recurrent dislocation of patella: a clinical and X-ray anatomic investigation. Acta Orthop. Scand. Suppl. 1964; 68 (Suppl): 1-148.
  22. Roux C. Luxation habituelle de la rotule: traitementoperatoire. Rev. Chir Orthop. 1888; 8: 682-9.
  23. Goldthwait J.E. Dislocation of the patella. Am. Orthop. Assn. 1895; 8: 237-8.
  24. Вреден Р.Р. Повреждения и заболевания костей и суставов нижних конечностей: Руководство по практической хирургии. т. 9. М.-Л.: Госмедиздат; 1931.
  25. Hauser E.D.W. Total tendon transplant for slipping patella. A new operation for recurrent dislocation of the patella. Surg. Gyn. Obst. 1938; 66: 199-214.
  26. Trillat A., Dejour H., Couette A. Diagnosis and treatment of recurrent dislocations of the patella. Rev. Chir. Orthop. Reparatrice Appar. Mot. 1964; 50: 813-24 (in French).
  27. Cox J.S. An evaluation of the Elmslie-Trillat procedure for management of patellar dislocations and subluxations: a preliminary report. Am. J. Sports Med. 1976; 4 (2): 72-7. doi: 10.1177/036354657600400204.
  28. Dandy D.J., Poirier H. Chondromalacia and the unstable patella. Acta Orthop. Scand.1975; 46 (4): 695-9.
  29. Fulkerson J. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin. Orthop. Relat. Res. 1983; (177): 176-81.
  30. Bandi W. Chondromalacia patellae and femoro-patellar arthrosis, etiology, clinical aspects and therapy. Helv. Chir. Acta. 1972; 39 (Suppl 11): 11-70.
  31. Maquet P. Advancement of the tibial tuberosity. Clin. Orthop. Relat. Res. 1976; (115): 225-30.
  32. Tsuda E., Ishibashi Y., Yamamoto Y., Maeda S. Incidence and radiologic predictor of postoperative patellar instability after Fulkerson procedure of the tibial tuberosity for recurrent patellar dislocation. Knee Surg. Sports Traumatol. Arthrosc. 2012; 20 (10): 2062-70. doi: 10.1007/ s00167-011-1832-2.
  33. Dejour H., Walch G., Nove-Josserand L., Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg. Sports Traumatol. Arthrosc. 1994; 2 (1): 19-26.
  34. Krogius A. Zur operative Behandlung der habituellen Luxation der Knieschelbe. Zbl. Chir. 1904; 31: 254-7.
  35. Campbell W.C., Edmonson J.H., Crenshaw J.R. Campbell’s operative orthopaedics. 6th ed. Elsevier (Mosby), Waltham; 1980.
  36. Yamamoto R.K. Arthroscopic repair of the medial retinaculum and capsule in acute patellar dislocations. Arthroscopy. 1986; 2 (2): 125-31.
  37. Shelbourne K.D., Urch S.E., Gray T. Results of medial retinacular imbrication in patients with unilateral patellar dislocation. J. Knee Surg. 2012; 25 (5): 391-6. doi: 10.1055/s-0032-1313750.
  38. Sillanpaa P.J., Maenpaa H.M., Mattila V.M. et al. Arthroscopic surgery for primary traumatic patellar islocation: a prospective, nonrandomized study comparing patients treated with and without acute arthroscopic stabilization with a median 7-year follow-up. Am. J. Sports Med. 2008; 36 (12): 2301-9. doi: 10.1177/0363546508322894.
  39. Cerciello S., Lustig S., Costanzo G., Neyret P. Medial retinaculum reefing for the treatment for patellar instability. Knee Surg. Sports Traumatol. Arthrosc. 2014; 22 (10): 2505-12. doi: 10.1007/s00167-014-3171-6.
  40. Кузнецов И.А., Фомин Н.Ф., Салихов М.Р. и др. Клинико-анатомическое обоснование оптимальных артроскопических доступов к локтевому суставу. Травматология и ортопедия России. 2015; (1): 32-41. doi: 10.21823/2311-2905-2015-0-1-32-41.
  41. Kaplan E.B. Factors responsible for the stability of the knee joint. Bull. Hosp. Joint Dis. 1957; 18: 51-9.
  42. Placella G., Tei M., Sebastiani E. et al. Anatomy of the medial patello-femoral ligament: a systematic review of the last 20 years literature. Musculoskelet. Surg. 2015; 99 (2): 93-103. doi: 10.1007/s12306-014-0335-y.
  43. Nomura E., Inoue M., Osada N. Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment. Knee Surg. Sports Traumatol. Arthrosc. 2005; 13 (7): 510-5. doi: 10.1007/s00167-004-0607-4.
  44. Heegaard J., Leyvraz P.F., Van Kampen A. et al. Influence of soft structures on patellar three-dimensional tracking. Clin. Orthop. Relat. Res. 1994; (299): 35-43.
  45. Desio S.M., Burks R.T., Bachus K.N. Soft tissue restraints to lateral patellar translation in the human knee. Am. J. Sports Med. 1998; 26 (11): 59-65. doi: 10.1177/03635465980260012701.
  46. Feller J.A., Amis A.A., Andrish J.T. et al. Surgical biomechanics of the patellofemoral joint. Arthroscopy. 2007; 23 (5): 542-53.
  47. Nomura E., Horiuchi Y., Kihara M. Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee. 2000; 7 (2): 121-7.
  48. Mountney J., Senavongse W., Amis A.A., Thomas N.P. Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. J. Bone Joint Surg. Br. 2005; 87 (1): 36-40.
  49. Arendt E.A. MPFL reconstruction for PF instability: the soft (tissue) approach. Orthop. Traumatol. Surg. Res. 2009; 95 (8 Suppl 1): S97-100.
  50. Ahmad C.S., Brown G.D., Stein B.S. The docking technique for medial patellofemoral ligament reconstruction: surgical technique and clinical outcome. Am. J. Sports Med. 2009; 37 (10): 2021-7. doi: 10.1177/0363546509336261.
  51. Nomura E., Inoue M., Kobayashi S. Long-term followup and knee osteoarthritis change after medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am. J. Sports Med. 2007; 35 (11): 1851-8. doi: 10.1177/0363546507306161.
  52. Кузнецов И.А., Рябинин М.В., Рыбин А.В., Соседов П.Ю. Способ реконструкции медиальной пателло-феморальной связки. Патент РФ № 2520254, 2014.
  53. Schottle P.B., Romero J., Schmeling A., Weiler A. Technical note: anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft. Arch. Orthop. Trauma Surg. 2008; 128: 479-84.
  54. Nomura E., Inoue M. Surgical technique and rationale for medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Arthroscopy. 2003; 19 (5): E47. doi: 10.1053/jars.2003.50167.
  55. Schottle P.B., Schmeling A., Rosenstiel N., Weiler A. Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am. J. Sports Med. 2007; 35 (5): 801-4. doi: 10.1177/0363546506296415.
  56. Elias J.J., Cosgarea A.J. Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage: a computational analysis. Am. J. Sports Med. 2006; 34 (9): 1478-85. doi: 10.1177/0363546506287486.
  57. Smith T.O., Walker J., Russell N. Outcomes of medial patellofemoral ligament reconstruction for patellar instability: a systematic review. Knee Surg. Sports Traumatol. Arthrosc. 2007; 15 (11): 1301-14. doi: 10.1007/s00167-007-0390-0.
  58. Watanabe T., Muneta T., Ikeda H. et al. Visual analog scale assessment after medial patellofemoral ligament reconstruction: with or without tibial tubercle transfer. J. Orthop. Sci. 2008; 13 (1): 32-8. doi: 10.1007/s00776-007-1196-0.
  59. Ronga M., Oliva F., Longo U.G. et al. Isolated medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am. J. Sports Med. 2009; 37 (9): 1735-42. doi: 10.1177/0363546509333482.
  60. Enderlein D., Nielsen T., Christiansen S.E. et al. Clinical outcome after reconstruction of the medial patellofemoral ligament in patients with recurrent patella instability. Knee Surg. Sports Traumatol. Arthrosc. 2014; 22 (10): 2458-64. doi: 10.1007/s00167-014-3164-5.



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