Management of Patellofemoral Instability: Trochleoplasty, Osteotomy, Ligament Reconstruction, Cartilage Restoration, and Resurfacing.

Patellar instability is a complex, multifactorial condition with a broad spectrum of clinical presentations. Effective management requires a tailored, à la carte approach that addresses both soft-tissue and bony contributors. The medial patellofemoral ligament reconstruction remains the primary surgical option for soft-tissue stabilization, although the medial quadriceps tendon-femoral ligament reconstruction has emerged as a promising alternative in addition to a hybrid technique. In cases of significant bony abnormalities, osteotomies can help optimize patellar tracking. Specifically, trochleoplasty is a powerful tool for patients with severe trochlear dysplasia and has demonstrated favorable long-term outcomes. The presence of cartilage lesions may affect the outcomes of management of patellar instability. Cartilage restoration procedures such as osteochondral allografts or autologous chondrocyte implantation may be used to preserve joint function and improve patient outcomes.