Patellofemoral Instability in Sport

This session included presentations on: Imaging for PF instability; Non-surgical treatment of PF instability; My approach to surgical management of patella instability in elite athletes; Can patella realignment get athletes back to the top?; and The role of rotational malalignment.

Patellar instability does exist in elite level sport. The patellofemoral joint (PFJ) is inherently unstable and this instability is added to by a range of trochlear and patellar morphologies, patella height and the pull of the Q angle. Imaging can be used to assess trochlear/patellar dysplasia, patella position, lateralisation of the tibial tuberosity, the effect on the PFJ hyaline cartilage and superolateral fat pad oedema. Non-operative interventions include addressing biomechanics, balancing load and capacity and building confidence as well as being realistic about expectations vs demands. Surgically, the aim is to normalise the anatomy without introducing new abnormality and return to top level function is possible. Rotational malalignment is another cause of PF instability, pain and arthritis. De-rotational osteotomy is a very powerful, logical and successful treatment but uptake is low, reflecting difficulties with measurement techniques and the aggressive nature of the surgical intervention.