RESEARCH ARTICLE


The Operative Management of Patella Malalignment



Alexios Dimitrios Iliadis*, 1, Parag Kumar Jaiswal 1, Wasim Khan 2, David Johnstone 3
1 The Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
2 University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
3 Stoke Manderville Hospital, Aylesbury, Buckinghamshire, HP21 8AL, UK


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© Iliadis et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK; Tel: 07782106187; Fax: 08721157775; E-mail: alexiliadis@mail.com


Abstract

Management of patellofemoral joint pathology is challenging as a result of the unique and complex organization of static forces and dynamic factors contributing to its functional capacity. Anterior knee pain is a common musculoskeletal complaint seen daily in the practices of primary care physicians, rheumatologists, and orthopedic surgeons. The key to successful treatment lies not only in the correct diagnosis of a chondral defect, but more importantly, in the accurate identification of associated pathomechanical factors. Appreciating the pathoanatomic basis of the disease and addressing imbalances and anatomical abnormalities should guide treatment.

Despite the complexity of the interplay of various components it is essential to attempt to describe patellar malalignement as a clinical entity in order to proceed with appropriate surgical management and successful outcomes. The goals of patellofemoral re- alignment surgery should be to create both a stable environment for optimal extensor mechanism performance and an appropriate load transmission for optimal cartilage wear and joint loading. In the context of this article we will review the operative management of patellofemoral malalignment; the indications for surgery, the different techniques available and the evidence regarding their effectiveness.

A large number of procedures have been employed and they have all undergone various modifications over the course of the years. The majority of publications are retrospective series in poorly defined population groups. There are significant methodological inconsistencies and as a result there is lack of strong evidence base for the majority of these procedures.

Keywords: Anterior knee pain, instability, joint, review literature, operative procedures.